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Analysis of technique and patient survival over time in patients undergoing peritoneal dialysis

  • Nephrology - Original Paper
  • Published:
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Abstract

Purpose

This study used national claims data to investigate the technique and patient survival over time in incident peritoneal dialysis (PD) patients.

Methods

Incident end-stage renal disease patients undergoing PD and older than 18 years were selected from Taiwan health insurance databases. These patients were grouped into three study periods according to year of dialysis initiation: 1997–2001, 2002–2006, and 2007–2011. The study end-points included technique failure and mortality.

Results

The patients in the most recent era were older and more likely to have higher levels of comorbidity. Compared with the 1997–2001 group, the risks of technique failure were similar in the in the 2002–2006 (hazard ratio [HR] 1.10, 95 % confidence interval [CI] 0.98–1.24) and 2007–2011 groups (HR 1.11, 95 % CI 0.98–1.26), respectively. Relative to the 1997–2001 group, the risks of mortality were higher in the 2002–2006 group (HR 1.59, 95 % CI 1.26–2.02) and similar in the 2007–2011 group (HR 1.20, 95 % CI 0.93–1.55). Using icodextrin and automated peritoneal dialysis (APD) were associated with lower risks of technique failure (HR 0.62 and 0.86, 95 % CI 0.56–0.68 and 0.77–0.95, respectively) and mortality (HR 0.55 and 0.81, 95 % CI 0.45–0.66 and 0.67–0.99, respectively).

Conclusions

Despite increase in disease burden in the most recent era, the outcomes remained relatively stable. The use of APD and icodextrin appears to have significantly ameliorated the impact of the increase in comorbidity burden.

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Acknowledgments

The present study was supported China Medical University Hospital (DMR-101-044, DMR-105-021, and DMR-104-015); the research laboratory of pediatrics, Children’s Hospital of China Medical University; the Clinical Trial and Research Center of Excellence, Ministry of Health and Welfare (MOHW105-TDU-B-212-133019); Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM10501010037); the Stroke Clinical Trial Consortium, National Research Program for Biopharmaceuticals (MOST 104-2325-B-039-005); the Tseng-Lien Lin Foundation, Taichung, Taiwan; the Taiwan Brain Disease Foundation, Taipei, Taiwan; and the Katsuzo and Kiyo Aoshima Memorial Funds, Japan. All the authors declared that they have no relevant financial interests.

Author contributors

I-Kuan Wang designed the study and drafted the manuscript. Chih-Hsin Muo designed the study and conducted the statistical analysis. Chi-Yu Lu, Chiz-Tzung Chang, and Tzung-Hai Yen designed the study and drafted the manuscript. Tsai-Chung Li, Chiu-Ching Huang, and Fung-Chang Sung designed the study and revised the manuscript.

Funding/support

This study was supported in part by the Taiwan Ministry of Health and Welfare Clinical Trial and Research Center of Excellence (MOHW105-TDU-B-212-133019); the research laboratory of pediatrics, Children’s Hospital of China Medical University, China Medical University (DMR-101-044, DMR-105-021, and DMR-104-015); Academia Sinica Taiwan Biobank, Stroke Biosignature Project (BM10501010037); National Research Program for Biopharmaceuticals Stroke Clinical Trial Consortium (MOST 104-2325-B-039-005); Tseng-Lien Lin Foundation, Taichung, Taiwan; Taiwan Brain Disease Foundation, Taipei, Taiwan; and Katsuzo and Kiyo Aoshima Memorial Funds, Japan.

Author information

Authors and Affiliations

  1. Graduate Institute of Clinical Medical Science, China Medical University, 91 Hsueh Shih Road, Taichung, 404, Taiwan

    I-Kuan Wang & Fung-Chang Sung

  2. Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    I-Kuan Wang & Chiu-Ching Huang

  3. Division of Nephrology, China Medical University Hospital, Taichung, Taiwan

    I-Kuan Wang, Chiz-Tzung Chang & Chiu-Ching Huang

  4. Department of Biochemistry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

    Chi-Yu Lu

  5. Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Chih-Hsin Muo

  6. College of Medicine, China Medical University, Taichung, Taiwan

    Chih-Hsin Muo

  7. Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan

    Tzung-Hai Yen

  8. College of Medicine, Chang Gung University, Taoyuan, Taiwan

    Tzung-Hai Yen

  9. Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan

    Tsai-Chung Li

  10. Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan

    Tsai-Chung Li

  11. Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan

    Fung-Chang Sung

  12. Faculty of Public Health, Mahidol University, Bangkok, Thailand

    Fung-Chang Sung

Authors
  1. I-Kuan Wang
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  2. Chi-Yu Lu
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  3. Chih-Hsin Muo
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  4. Chiz-Tzung Chang
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  5. Tzung-Hai Yen
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  6. Chiu-Ching Huang
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  8. Fung-Chang Sung
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Corresponding author

Correspondence to Fung-Chang Sung.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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For this type of study formal consent is not required.

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Wang, IK., Lu, CY., Muo, CH. et al. Analysis of technique and patient survival over time in patients undergoing peritoneal dialysis. Int Urol Nephrol 48, 1177–1185 (2016). https://doi.org/10.1007/s11255-016-1296-x

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  • DOI: https://doi.org/10.1007/s11255-016-1296-x

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