International

Renal Anaemia in the news

Move from peritoneal dialysis to hemodialysis does not worsen survival

• 23 February 2009
• Reuters Health

By Will Boggs, MD

NEW YORK (Reuters Health) - Patients who must switch from peritoneal dialysis (PD) to hemodialysis (HD) do not have worse survival than patients who remain on PD, according to a prospective US study.

"The risk of switching from PD to HD (PD failure) remains high, despite improvement in PD techniques over the past few years," Dr. Bernard G. Jaar from Johns Hopkins University School of Medicine, Baltimore, Maryland, told Reuters Health. "Even more importantly, PD failure (switch to HD) is not necessarily associated with subsequent poor outcomes."

Dr. Jaar and his colleagues followed 262 PD patients in order to investigate characteristics associated with the risk of switching to HD and survival following the switch.

In the February 6th BMC Nephrology online, they report that 24.8% of patients switched to hemodialysis during the study period, with more than 70% of these switches occurring within the first 2 years.

The leading causes of switching from PD to HD were infections (peritonitis and catheter-related) (36.9%) and cardiovascular (fluid overload) (18.5%), the report indicates.

In the unadjusted model, black patients were almost 3 times more likely than white patients to switch from PD to HD, the researchers note, and "this risk became stronger after adjustment."

In addition, the risk of switching from PD to HD increased by about 10% for each unit increase in body mass index.

For patients who switched to HD, the risk of death was 11% lower than for non-switchers, the investigators say, but this difference was not statistically significant.

"We were somewhat surprised by the results, as we expected the PD patients who switched from PD to HD to do worse over time compared to the other PD patients who remained on PD," Dr. Jaar said. "However, these results, showing that PD technique failure is not necessarily associated with poor prognosis, should be reassuring to providers and patients."

"To date there is no clear explanation on why black patients are less likely to start PD and are also more likely to switch from PD to HD," Dr. Jaar said. "We plan to explore further the relationship between race and PD technique failure by looking at the patient education level, social support, and comorbid conditions."

BMC Nephrology 2009.