SP529WHAT FACTORS RELATE TO PERITONEAL DIALYSIS DROP OUT? RESULTS FROM A SINGLE UNITED KINGDOM CENTRE

Abstract

Introduction and Aims: Peritoneal dialysis (PD) has been in use world-wide for the last 3 decades as treatment of end-stage renal disease but barring a few countries the prevalence of PD as a dialysis option remains lower than Haemodialysis (HD). Our centre is no exception to this with less than 20% of the prevalent population choosing PD as a modality option. Of the ones who perform PD worldwide, few patients remain on it for 5 years or longer from initiation of therapy. A large proportion of patients transfer from PD to HD annually, with dropout rates of up to 35% and more reported. We wished to examine the dropout rate locally at our urban center situated in an ethnically diverse and economically challenged area and to determine what if any factors affect the dropout rate from PD. Methods: All patients who were commenced on PD from 2002 to 2012 were included in this observational study. Those who were transferred to a different dialysis centre during the course of the study period were excluded. Patients' demographic and medical information were collected electronically from the hospital and renal database. Comorbidity, cause of renal failure, biochemical parameters and the rate of PD peritonitis were also collated. Results: 193 patients were included in this study (62 % male, mean age 58years, 50% diabetic and 22% non-Caucasian). 18% of the group were in the high risk score for co-morbidity at the start of PD. Over the duration of the study period 155 switched to HD (80%) and 21 (11%) died and 17 (9%) were transplanted. The average length of duration on PD prior to change of modality was 15 months. The average length of duration on PD prior to transplant was 7.5 months. The patients that were switched to haemodialysis stayed 15.2 months on PD. Lastly those who died without being transplanted/dialysed stayed for 22.9 months on PD. Patients who switched to HD were more likely to be younger non-Caucasian and diabetic than those who were transplanted or died. The three main reasons for PD discontinuation were fluid overload because of ultrafiltration failure or poor compliance with salt and fluid restrictions (40%); peritonitis (30%); and preference of the physician, patient, or family (6%). Conclusions: Our centre has a higher than average rate of PD drop out than has been reported in other centres with 80% of patients switching to HD just over a year after starting PD. Younger, diabetic and non -Caucasian patients are more likely to switch to HD. The reasons for this are unclear but we propose the small size of our PD program and the free availability of HD has lowered the threshold to sustain patients on PD. Enhanced education of both patients and staff make be a way to change this in the future,.