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The availability of support and peritoneal dialysis survival: A cohort study. | LitMetric
Background : Providing support is important to maintain a patient on peritoneal dialysis (PD), though its impact on outcomes has not been investigated thoroughly. We examined the association between having support and risk of a transfer to hemodialysis.Methods : In this retrospective observational cohort study, we used data captured in the Dialysis Measurement Analysis and Reporting system about patients who started PD in Alberta, Canada, between 1 January 2013 and 30 September 2018. Support was defined as the availability of a support person in the home who was able, willing and available to provide support for PD in the patient's residence. The outcome of interest was a transfer to hemodialysis for at least 90 days. We estimated the cumulative incidence of a transfer over time accounting for competing risks and hazard ratios to summarise the association between support and a transfer. We split follow-up time as hazard ratios varied over time.Results : Six hundred and eighty-three incident PD patients, median age 58 years (: 47-68) and 35% female, were followed for a median of 15 months. The cumulative incidence of a transfer to hemodialysis at 24 months was 26%. Having support was associated with a reduced risk of a transfer between 3 and 12 months after the start of dialysis (HR: 0.44; 95% CI: 0.25-0.78), but not earlier (hazard ratio (HR): 0.96; 95% confidence interval (CI): 0.55-1.69) or later (HR: 1.19; 95% CI: 0.65-2.17).Conclusions : A transfer to hemodialysis is common. Having a support person at home is associated with a short-term protective effect after the initiation of PD.
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