Division of Nephrology, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Thailand.
Department of Family and Preventive Medicine, Faculty of Medicine, Prince of Songkla University, Thailand.
Perit Dial Int. 2023 Jan;43(1):64-72. doi: 10.1177/08968608221081521. Epub 2022 Mar 3.
Haemodialysis (HD) transfer (HDT) is the major challenge of peritoneal dialysis (PD). This study aimed to analyse the time-dependent incidence rates and risk factors for permanent HDT in patients under Thailand's PD First policy.
The records of 20,545 patients from January 2008 to June 2018 were studied. The time on therapy (TOT) was divided into 0-3, 3-12, 12-24, 24-36, 36-48 and more than 48 months. The time-dependent incidence rates and causes of PD dropout were investigated. The risk factors for HDT were analysed by multivariable Poisson regression model and presented as incidence rate ratios (IRRs) and 95% confidence intervals (CIs).
The main cause of PD dropout was death (45.7%) with 17.4% of the patients transferred to HD. The median (25th to 75th interquartile range) dialysis vintage was 1.4 (0.5-2.7) years. The incidence rates of HDT increased with TOT. Patients with universal coverage were transferred to HD less frequently than those with other health schemes. Patients who were illiterate or only had primary school education had a higher risk of being transferred to HD after 48 months of TOT (IRR 1.41 (95% CI 1.07-1.89)). Peritonitis within the first year of PD was the risk for HDT during 13-48 months of PD. The reasons for HDT changed with TOT. Mechanical complications followed by peritonitis were the main causes of HDT during the first 3 months, and after that peritonitis was the main reason.
The incidence of HDT increased with TOT. The risks for HDT changed over time on PD.
血液透析（HD）转归是腹膜透析（PD）的主要挑战。本研究旨在分析泰国 PD 优先政策下患者的永久性 HD 转归的时间依赖性发生率和危险因素。
对 2008 年 1 月至 2018 年 6 月的 20545 例患者的记录进行了研究。治疗时间（TOT）分为 0-3、3-12、12-24、24-36、36-48 和>48 个月。研究了 PD 退出的时间依赖性发生率和原因。通过多变量泊松回归模型分析了 HD 转归的危险因素，并以发生率比（IRR）和 95%置信区间（CI）表示。
PD 退出的主要原因是死亡（45.7%），其中 17.4%的患者转至 HD。中位（25 至 75 分位数）透析年限为 1.4（0.5-2.7）年。HD 转归的发生率随 TOT 而增加。全民覆盖的患者转至 HD 的频率低于其他健康计划的患者。未受过教育或仅受过小学教育的患者在 TOT 48 个月后转至 HD 的风险更高（IRR 1.41（95%CI 1.07-1.89））。PD 后 1 年内的腹膜炎是 PD 后 13-48 个月 HD 转归的危险因素。HD 转归的原因随 TOT 而变化。机械并发症紧随腹膜炎是前 3 个月 HD 转归的主要原因，此后腹膜炎是主要原因。
HD 转归的发生率随 TOT 而增加。PD 期间 HD 转归的风险随时间而变化。
