Number of Daily Peritoneal Dialysis Exchanges and Mortality Risk in a Chinese Population

Xueqing Yu, Institute of Nephrology, Guangdong Medical University, Guangdong, China.
Jianghua Chen, Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Zhaohui Ni, Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China.
Nan Chen, Department of Nephrology, Ruijin Hospital, the Medical School affiliated to Shanghai Jiaotong University, Shanghai, China.
Menghua Chen, Department of Nephrology, General Hospital of Ningxia Medical University, Ningxia, China.
Jie Dong, Renal Division, Department of Medicine, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, PR China.
Limeng Chen, Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 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.
Wei Fang, Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China.
Qiang Yao, Baxter China Ltd, Shanghai, People's Republic of 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.2017.00283

Keywords

Baxter; China; dialysis dose

Abstract

BACKGROUND: We report outcomes on ≥ 4 compared with < 4 exchanges/day in a Chinese cohort on continuous ambulatory peritoneal dialysis (CAPD). METHODS: Data were sourced from the Baxter (China) Investment Co. Ltd Patient Support Program database, comprising an inception cohort commencing CAPD between 1 January 2005 and 13 August 2015. We used cause-specific Cox proportional hazards and Fine-Gray competing risks (kidney transplantation, change to hemodialysis) models to estimate mortality risk on ≥ 4 compared with < 4 exchanges/day. We matched or adjusted for age, gender, employment, insurance, primary renal disease, size of CAPD program, year of dialysis inception, and treatment center. RESULTS: We modeled 100,022 subjects from 1,177 centers over 239,876 patient-years. Of these subjects, 43,185 received < 4 exchanges/day and 56,837 ≥ 4 exchanges/day. The proportion of patients on < 4 exchanges/day varied widely between centers. Those on < 4 exchanges/day were significantly older, more often female, of unknown employment, and from rural China. In the various models, ≥ 4 exchanges/day was associated with a significantly lower risk of death by 30% - 35% compared with < 4 exchanges/day. This beneficial effect was greatest in younger and rural patients. CONCLUSIONS: In this Chinese CAPD cohort, ≥ 4 exchanges/day was associated with significantly lower mortality risk than < 4 exchanges/day. Analyses are limited by residual confounding from unavailability of important prognostic covariates (e.g., comorbidity, socioeconomic factors) and data on residual renal function, peritoneal clearance, and transport status with which to judge the clinical appropriateness of CAPD prescription. Nonetheless, our study indicates this area as a high priority for further detailed study.

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