Abstract: TH-OR68
Return to Peritoneal Dialysis after a Hemodialysis Transfer: A Multistate Analysis of the Canadian Organ Replacement Register
Session Information
- Home Dialysis Hodgepodge: Novel Mechanisms, Solutions, Technologies, and Ideas
October 24, 2024 | Location: Room 8, Convention Center
Abstract Time: 05:10 PM - 05:20 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Desbiens, Louis-Charles, Universite de Montreal, Montreal, Quebec, Canada
- Goupil, Remi, Hopital du Sacre-Coeur de Montreal, Montreal, Quebec, Canada
- Tennankore, Karthik K., Dalhousie University, Halifax, Nova Scotia, Canada
- Perl, Jeffrey, St Michael's Hospital, Toronto, Ontario, Canada
- Trinh, Emilie, McGill University Health Centre, Montreal, Quebec, Canada
- Chan, Christopher T., University Health Network, Toronto, Ontario, Canada
- Nadeau-Fredette, Annie-Claire, Hopital Maisonneuve-Rosemont, Montreal, Quebec, Canada
Background
Transfers to hemodialysis (HD) are challenging for patients on peritoneal dialysis (PD). Clinical outcomes after these transfers are poorly known.
Methods
We analyzed patients from the Canadian Organ Replacement Registry (CORR) who received at least 30 days of PD between 2005 and 2019. All transfers from PD to facility HD were identified, regardless of their duration. Patients were followed until December 2019 for outcomes (death, kidney transplant, transfer to home HD, return to PD) and were censored if a second PD-to-HD transfer occurred. We used a multi-state modelization approach, treating different outcomes as states between which patients can sequentially transition.
Results
From 18,956 patients entering PD, 9,746 (51%) patients experienced a total of 18,683 PD-to-HD transfers (mean 1.92 transfers/patient, range 1 to 27) after a median vintage of 1.8 years. Populational trajectories after these transfers are displayed in Figure 1a. A majority of patients (66%) resumed PD in the following year; this odd was highest during the first months and sharply fell afterwards (Figure 1b). Mortality rates were also high following a PD-to-HD transfer, but resuming PD remained more likely than death up to nine months after the transfer (Figure 1c). Five years after a transfer, 50% of patients had died, 6% of patients had transferred to home HD and 34% had received a transplant.
Conclusion
Transfers to HD are common among patients receiving PD in Canada, and, despite a heighten post-transfer mortality risk, a majority of patients can resume PD. These findings identify the post-transfer window as a key period to enhanced clinical care (e.g. using a nurse navigator) in order to improve patients’ outcomes.
Funding
- Government Support – Non-U.S.