Title

The Effect of Automated Versus Continuous Ambulatory Peritoneal Dialysis on Mortality Risk In China

Authors

Xuemei Li, Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Hong Xu, Department of Nephrology, Children's Hospital of Fudan University, Shanghai, China.
Nan Chen, Department of Nephrology, Ruijin Hospital, the Medical School affiliated to Shanghai Jiaotong University, Shanghai, China.
Zhaohui Ni, Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China.
Menghua Chen, Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China.
Limeng Chen, Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Jie Dong, Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, PR China.
Wei Fang, Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China.
Yusheng Yu, Research Institute of Nephrology, Jinling Hospital, Nanjing University School of Medicine, Nanjing, China.
Xiao Yang, Department of Nephrology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Jianghua Chen, Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Xueqing Yu, Institute of Nephrology, Guangdong Medical University, Dongguan, Guangdong, China.
Qiang Yao, Baxter China Ltd, Shanghai, China.
James A. Sloand, Baxter Healthcare International, Deerfield, IL, USA.
Mark R. Marshall, Baxter Healthcare (Asia) Pte Ltd, Singapore mark_roger_marshall@baxter.com markrogermarshall@icloud.com.

Document Type

Journal Article

Publication Date

12-1-2018

Journal

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis

Volume

38

Issue

Suppl 2

DOI

10.3747/pdi.2017.00235

Keywords

Automated peritoneal dialysis; Baxter; epidemiology

Abstract

BACKGROUND: There is an emerging practice pattern of automated peritoneal dialysis (APD) in China. We report on outcomes compared to continuous ambulatory peritoneal dialysis (CAPD) in a Chinese cohort. METHODS: Data were sourced from the Baxter Healthcare (China) Investment Co. Ltd Patient Support Program database, comprising an inception cohort commencing PD between 1 January 2005 and 13 August 2015. We used time-dependent cause-specific Cox proportional hazards and Fine-Gray competing risks (kidney transplantation, change to hemodialysis) models to estimate relative mortality risk between APD and CAPD. We adjusted or matched for age, gender, employment, insurance, primary renal disease, size of PD program, and year of dialysis inception. We used cluster robust regression to account for center effect. RESULTS: We modeled 100,351subjects from 1,178 centers over 240,803 patient-years. Of these, 368 received APD at some time. Compared with patients on CAPD, those on APD were significantly younger, more likely to be male, employed, self-paying, and from larger programs. Overall, APD was associated with a hazard ratio (HR) for death of 0.79 (95% confidence interval [CI] 0.64 - 0.97) compared with CAPD in Cox proportional hazards models, and 0.76 (0.62 - 0.95) in Fine-Gray competing risks regression models. There was prominent effect modification by follow-up time: benefit was observed only up to 4 years follow-up, after which risk of death was similar. CONCLUSION: Automated peritoneal dialysis is associated with an overall lower adjusted risk of death compared with CAPD in China. Analyses are limited by the likelihood of important selection bias arising from group imbalance, and residual confounding from unavailability of important clinical covariates such as comorbidity and Kt/V.

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