Technique failure in peritoneal dialysis: modifiable causes and patient-specific risk factors

Bonenkamp, A.A.; Sluijs, A.V. van der; Dekker, F.W.; Struijk, D.G.; Fijter, C.W. de; Vermeeren, Y.M.; ... ; DOMESTICO Study Grp (2022)

Article / Letter to editor

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.

• Reasons for failure
• risk factors
• technique failure
• technique survival
• standardised definition

• All authors: Bonenkamp, A.A.; Sluijs, A.V. van der; Dekker, F.W.; Struijk, D.G.; Fijter, C.W. de; Vermeeren, Y.M.; Ittersum, F.J. van; Verhaar, M.C.; Jaarsveld, B.C. van; Abrahams, A.C.; DOMESTICO Study Grp
• Date: 2022-02-23
• Journal: Peritoneal Dialysis International
• DOI: doi:10.1177/08968608221077461
• Link: https://journals.sagepub.com/doi/10.1177/08968608221077461