Predictive Factors for Withdrawal from Peritoneal Dialysis: A Retrospective Cohort Study at Two Centers in Japan.

ABSTRACT

Peritoneal dialysis (PD) is recognized as an excellent method of dialysis because the therapy is gentle, continuous, and cost-effective. However, a large number of patients must unfortunately transfer from PD to hemodialysis because of peritonitis or fluid overload in the early phase after PD initiation. In the present study, we reviewed clinical indicators before PD initiation to try to identify predictive factors for early withdrawal from PD.For this retrospective cohort study at two hospitals between March 2003 and October 2016, we defined withdrawal from PD as the induction of combination therapy, transfer to hemodialysis, or death. Data about clinical indicators before PD induction-namely age, sex, presence of diabetes mellitus, past history of cardiovascular disease (CVD), body mass index, primary kidney disease, and blood biochemistry-were collected from medical records. The primary outcome was duration of PD until withdrawal.We analyzed 151 PD patients (median age 62.5 years; 94 men; 74 with diabetes mellitus; median duration of PD 30.2 months). Univariate Cox regression analysis showed that the hazard ratio (HR) for withdrawal was 1.08 [95% confidence interval (CI) 1.04 to 1.12; p < 0.001] per 1 mg/L increase in ß2-microglobulin (ß2MG), 0.65 (95% CI 0.46 to 0.93; p = 0.02) per 1 g/dL decrease in serum albumin, and 1.07 (95% CI 1.02 to 1.11; p = 0.01) per 1 g per gram creatinine increase in daily urinary protein excretion. Using multivariate Cox regression analysis, ß2MG (HR 1.08; 95% CI 1.04 to 1.12; p < 0.001) and past history of CVD (HR 1.47; 95% CI 1.02 to 2.13; p = 0.04) were factors predictive for withdrawal from PD. Kaplan-Meier analysis showed that the technique survival rate was significantly different in the two groups defined as having a serum ß2MG level above or below the measured median (p = 0.047).Serum ß2MG at PD initiation and past history of CVD are high-risk factors for withdrawal from PD. Special focus should be placed on the care and management of patients found to have a high risk of withdrawal at the time of PD induction.