TY - JOUR
T1 - Technique failure in peritoneal dialysis
T2 - Modifiable causes and patient-specific risk factors
AU - Bonenkamp, Anna A
AU - der Sluijs, Anita van Eck van
AU - Dekker, Friedo W
AU - Struijk, Dirk G
AU - de Fijter, Carola Wh
AU - Vermeeren, Yolande M
AU - van Ittersum, Frans J
AU - Verhaar, Marianne C
AU - van Jaarsveld, Brigit C
AU - Abrahams, Alferso C
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The retrospective part of the ‘Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes’ is supported by a grant of the Dutch Kidney Foundation (grant no: A2D4P02). The sponsor had no role in the design and conduct of the study and no role in writing or in the decision to publish this article.
Publisher Copyright:
© The Author(s) 2022.
PY - 2023/1
Y1 - 2023/1
N2 - BACKGROUND: Technique survival is a core outcome for peritoneal dialysis (PD), according to Standardized Outcomes in Nephrology-Peritoneal Dialysis. This study aimed to identify modifiable causes and risk factors of technique failure in a large Dutch cohort using standardised definitions.METHODS: Patients who participated in the retrospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes cohort study and started PD between 2012 and 2016 were included and followed until 1 January 2017. The primary outcome was technique failure, defined as transfer to in-centre haemodialysis for ≥ 30 days or death. Death-censored technique failure was analysed as secondary outcome. Cox regression models and competing risk models were used to assess the association between potential risk factors and technique failure.RESULTS: A total of 695 patients were included, of whom 318 experienced technique failure during follow-up. Technique failure rate in the first year was 29%, while the death-censored technique failure rate was 23%. Infections were the most common modifiable cause for technique failure, accounting for 20% of all causes during the entire follow-up. Leakage and catheter problems were important causes within the first 6 months of PD treatment (both accounting for 15%). APD use was associated with a lower risk of technique failure (hazard ratio 0.66, 95% confidence interval 0.53-0.83).CONCLUSION: Infections, leakage and catheter problems were important modifiable causes for technique failure. As the first-year death-censored technique failure rate remains high, future studies should focus on infection prevention and catheter access to improve technique survival.
AB - BACKGROUND: Technique survival is a core outcome for peritoneal dialysis (PD), according to Standardized Outcomes in Nephrology-Peritoneal Dialysis. This study aimed to identify modifiable causes and risk factors of technique failure in a large Dutch cohort using standardised definitions.METHODS: Patients who participated in the retrospective Dutch nOcturnal and hoME dialysis Study To Improve Clinical Outcomes cohort study and started PD between 2012 and 2016 were included and followed until 1 January 2017. The primary outcome was technique failure, defined as transfer to in-centre haemodialysis for ≥ 30 days or death. Death-censored technique failure was analysed as secondary outcome. Cox regression models and competing risk models were used to assess the association between potential risk factors and technique failure.RESULTS: A total of 695 patients were included, of whom 318 experienced technique failure during follow-up. Technique failure rate in the first year was 29%, while the death-censored technique failure rate was 23%. Infections were the most common modifiable cause for technique failure, accounting for 20% of all causes during the entire follow-up. Leakage and catheter problems were important causes within the first 6 months of PD treatment (both accounting for 15%). APD use was associated with a lower risk of technique failure (hazard ratio 0.66, 95% confidence interval 0.53-0.83).CONCLUSION: Infections, leakage and catheter problems were important modifiable causes for technique failure. As the first-year death-censored technique failure rate remains high, future studies should focus on infection prevention and catheter access to improve technique survival.
KW - Reasons for failure
KW - risk factors
KW - standardised definition
KW - technique failure
KW - technique survival
UR - http://www.scopus.com/inward/record.url?scp=85125375593&partnerID=8YFLogxK
U2 - 10.1177/08968608221077461
DO - 10.1177/08968608221077461
M3 - Article
C2 - 35193426
SN - 0896-8608
VL - 43
SP - 73
EP - 83
JO - Peritoneal Dialysis International
JF - Peritoneal Dialysis International
IS - 1
ER -