Medicine and Health Sciences, Keele University, Keele, United Kingdom.
Arbor Research Collaborative for Health, Ann Arbor, Michigan.
Clin J Am Soc Nephrol. 2022 Jun;17(6):861-871. doi: 10.2215/CJN.16341221.
Quantifying contemporary peritoneal dialysis time on therapy is important for patients and providers. We describe time on peritoneal dialysis in the context of outcomes of hemodialysis transfer, death, and kidney transplantation on the basis of the multinational, observational Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS) from 2014 to 2017.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Among 218 randomly selected peritoneal dialysis facilities (7121 patients) in the PDOPPS from Australia/New Zealand, Canada, Japan, Thailand, the United Kingdom, and the United States, we calculated the cumulative incidence from peritoneal dialysis start to hemodialysis transfer, death, or kidney transplantation over 5 years and adjusted hazard ratios for patient and facility factors associated with death and hemodialysis transfer.
Median time on peritoneal dialysis ranged from 1.7 (interquartile range, 0.8-2.9; the United Kingdom) to 3.2 (interquartile range, 1.5-6.0; Japan) years and was longer with lower kidney transplantation rates (range: 32% [the United Kingdom] to 2% [Japan and Thailand] over 3 years). Adjusted hemodialysis transfer risk was lowest in Thailand, but death risk was higher in Thailand and the United States compared with most countries. Infection was the leading cause of hemodialysis transfer, with higher hemodialysis transfer risks seen in patients having psychiatric disorder history or elevated body mass index. The proportion of patients with total weekly Kt/V ≥1.7 at a facility was not associated with death or hemodialysis transfer.
Countries in the PDOPPS with higher rates of kidney transplantation tended to have shorter median times on peritoneal dialysis. Identification of infection as a leading cause of hemodialysis transfer and patient and facility factors associated with the risk of hemodialysis transfer can facilitate interventions to reduce these events.
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_05_31_CJN16341221.mp3.
量化患者和医护人员接受腹膜透析治疗的实际时间非常重要。我们根据 2014 年至 2017 年期间多国、观察性腹膜透析结局和实践模式研究（PDOPPS），描述了接受血液透析转归、死亡和肾脏移植的患者腹膜透析时间。
在 PDOPPS 中，我们从澳大利亚/新西兰、加拿大、日本、泰国、英国和美国的 218 家随机选择的腹膜透析中心（7121 例患者）中计算了从开始腹膜透析到血液透析转归、死亡或肾脏移植的 5 年累积发生率，并调整了与死亡和血液透析转归相关的患者和中心因素的风险比。
腹膜透析时间中位数范围为 1.7 年（四分位距，0.8-2.9；英国）至 3.2 年（四分位距，1.5-6.0；日本），且肾脏移植率越低时间越长（3 年内范围为 32%[英国]至 2%[日本和泰国]）。与大多数国家相比，泰国的血液透析转归风险最低，但死亡风险更高。感染是血液透析转归的主要原因，有精神疾病史或体重指数升高的患者发生血液透析转归的风险更高。中心每周总 Kt/V≥1.7 的患者比例与死亡或血液透析转归无关。
PDOPPS 中肾脏移植率较高的国家腹膜透析时间中位数往往较短。将感染确定为血液透析转归的主要原因以及与血液透析转归风险相关的患者和中心因素，有助于实施干预措施以减少这些事件。
