The rate and predictors of technique failure in Thai patients on peritoneal dialysis using competing risk analysis

Pornpen Sangthawan¹, Nintita Sripaiboonkij Thokanit² , Jirayut Janma³ , Siribha Changsirikulchai³

Renal Division, Department of Medicine, Faculty of Medicine, Prince of Songkla University, Thailand¹ Ramathibodi Comprehensive Cancer Center, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Thailand² Renal Division, Department of Medicine, Faculty of Medicine, Srinakharinwirot University,
Thailand³

Purpose: Technique failure is a major cause of withdrawal from peritoneal dialysis (PD). Previous studies showed variation of rates and predictors of technique failure, probably from using different definition and statistical method. This study aims to determine rates and independent predictors of technique failure using a competing risk analysis in a large cohort of  Thai patients on PD.

Method: Data from Database of Peritoneal dialysis in EXcel (DPEX) during 2008 to 2018 was analyzed. Technique failure was defined to patients who transferred to permanent hemodialysis (HD) for 60 days or longer. The cumulative incidence rate of technique failure was calculated. The competing risks with technique failure were death and kidney transplantation (KT). Predictors of technique failure were analyzed using competing-risk regression model.

Result: There were 20,840 patients included in this study. The median (IQR) follow up time was 18.2 ( 6.9-36.4) months. Patients who shifted to HD, KT, and death were 3,619 (17.4%), 237 (1.1%) and 9,530 (45.7%) cases, respectively. The cumulative incidence rate of technique failure was 6.7% at 12 months and 11.9% at 24 months. The independent predictors of technique failure were female with SHR 0.86 (95%CI 0.80-0.91), age 40-60 years old with SHR 0.77 (0.71-0.84),
age higher than 60 years old with SHR 0.50(0.45-0.54) compare to age less than 40 years old. Patient who had peritonitis in the first year of initiation PD had SHR 1.29(1.14-1.47).

Conclusion: Female gender, age and history of peritonitis in the first year of starting PD are predictors of technique failure.