Analysis of technique and patient survival over time in patients undergoing peritoneal dialysis

This study used national claims data to investigate the technique and patient survival over time in incident peritoneal dialysis (PD) patients. Incident end-stage renal disease patients undergoing PD and older than 18 years were selected from Taiwan health insurance databases. These patients were grouped into three study periods according to year of dialysis initiation: 1997-2001, 2002-2006, and 2007-2011. The study end-points included technique failure and mortality. The patients in the most recent era were older and more likely to have higher levels of comorbidity. Compared with the 1997-2001 group, the risks of technique failure were similar in the in the 2002-2006 (hazard ratio [HR] 1.10, 95 % confidence interval [CI] 0.98-1.24) and 2007-2011 groups (HR 1.11, 95 % CI 0.98-1.26), respectively. Relative to the 1997-2001 group, the risks of mortality were higher in the 2002-2006 group (HR 1.59, 95 % CI 1.26-2.02) and similar in the 2007-2011 group (HR 1.20, 95 % CI 0.93-1.55). Using icodextrin and automated peritoneal dialysis (APD) were associated with lower risks of technique failure (HR 0.62 and 0.86, 95 % CI 0.56-0.68 and 0.77-0.95, respectively) and mortality (HR 0.55 and 0.81, 95 % CI 0.45-0.66 and 0.67-0.99, respectively). Despite increase in disease burden in the most recent era, the outcomes remained relatively stable. The use of APD and icodextrin appears to have significantly ameliorated the impact of the increase in comorbidity burden.