Risk factors and outcomes in patients who switched from peritoneal dialysis to physician-oriented or patient-oriented kidney replacement therapy

Figures & data

Table 1. Baseline characteristics of the included patients.

	Total (n = 257)	Patient-oriented (n = 162)	Physician-oriented (n = 95)	P-value
Demographics
Age at catheterization (years)	35 (29,47)	34 (28,43)	43 (32,51)	<0.001
Male gender (%)	179 (69.6%)	111 (68.5%)	68 (71.6%)	0.606
BMI (kg/m^2)	21.63 (19.96,24.06)	21.01 (19.50,23.90)	22.52 (20.80,24.40)	0.004
The leading cause of ESKD				0.051
Primary glomerulopathy (%)	210 (81.7%)	138 (85.2%)	72 (75.8%)
Hypertensive nephropathy (%)	22 (8.6%)	12 (7.4%)	10 (10.5%)
Diabetic Nephropathy (%)	9 (3.5%)	2 (1.2%)	7 (7.4%)
Others (%)	16 (6.2%)	10 (6.2%)	6 (6.3%)
SBP (mmHg)	148.23 ± 18.71	147.84 ± 18.59	148.89 ± 19.01	0.673
DBP (mmHg)	96.65 ± 13.37	97.93 ± 12.75	94.49 ± 14.16	0.057
History of DM (%)	14 (5.4%)	2 (1.2%)	12 (12.6%)	<0.001
History of CAD (%)	5 (1.9%)	2 (1.2%)	3 (3.2%)	0.542
Marital status				0.005
Unmarried (%)	41 (16.0%)	35 (21.6%)	6 (6.3%)
Married (%)	208 (80.9%)	122 (75.3%)	86 (90.5%)
Divorced (%)	8 (3.1%)	5(3.1%)	3 (3.2%)
Education level				<0.001
Primary school or below (%)	16 (6.2%)	6 (3.7%)	10 (10.5%)
Junior high school (%)	77 (30.0%)	41 (25.3%)	36 (37.9%)
Senior high school or vocational high school (%)	49 (19.1%)	28 (17.3%)	21 (22.1%)
Junior college (%)	61 (23.7%)	43 (26.5%)	18 (18.9%)
Bachelor’s degree or above (%)	54 (21.0%)	44 (27.2%)	10 (10.5%)
annual household income				0.009
Less than 10,000 RMB (%)	4 (1.6%)	2 (1.3%)	2 (2.2%)
10,000–20,000 RMB (%)	7 (2.8%)	1 (0.6%)	6 (6.5%)
20,000–40,000 RMB (%)	36 (14.5%)	20 (12.9%)	16 (17.2%)
40,000–70,000 RMB (%)	79 (31.9%)	47 (30.3%)	32 (34.4%)
70,000–100,000 RMB (%)	70 (28.2%)	48 (31.0%)	22 (23.7%)
More than 100,000 RMB (%)	52 (21.0%)	37 (23.9%)	15 (16.1%)
Serum biochemical indexes
ALB (g/L)	39.56 ± 4.65	40.13 ± 4.22	38.63 ± 5.18	0.013
PA (mg/L)	399.34 ± 79.19	401.95 ± 78.54	394.91 ± 80.54	0.502
BUN (mmol/L)	17.34 (13.85,21.38)	17.52 (13.70,21.34)	17.30 (14.11,21.43)	0.744
Scr (μmol/L)	833.00 (671.00,1045.00)	857.50 (683.70,1058.15)	802.85 (653.30,1028.08)	0.391
UA (μmol/L)	419.40 (352.55,463.35)	414.00 (347.50,459.35)	420.00 (360.25,469.30)	0.298
Ca (mmol/L)	2.26 (2.14,2.41)	2.30(2.17,2.41)	2.21 (2.07,2.40)	0.050
P (mmol/L)	1.46 (1.26,1.76)	1.45 (1.26,1.78)	1.49 (1.25,1.75)	0.975
Hb (g/L)	110.97 ± 20.59	112.06 ± 18.97	109.16 ± 23.03	0.282
FBG (mmol/L)	4.92 (4.51,5.24)	4.89 (4.45,5.16)	4.98 (4.61,5.54)	0.023
TG (mmol/L)	1.51 (1.17,1.96)	1.54 (1.20,1.98)	1.48 (1.09,1.92)	0.295
TC (mmol/L)	4.85 ± 1.11	4.79 ± 1.00	4.94 ± 1.27	0.304
HDL-C (mmol/L)	1.14 (0.99,1.39)	1.14 (0.99,1.40)	1.15 (0.99,1.37)	0.917
LDL-C (mmol/L)	2.84 ± 0.85	2.76 ± 0.80	2.98 ± 0.92	0.046
iPTH (pg/mL)	327.10 (199.63,488.50)	348.70 (204.40,529.10)	292.10 (188.50,425.45)	0.123
PD-related variables
Types of PD (CAPD, %)	218 (84.8%)	139(85.8%)	79(83.2%)	0.568
24-h urine output (mL)	800.00 (500.00,1200.00)	800.00(498.00,1250.00)	819.65 (500.00,1185.00)	0.942
Total Kt/V	2.13 (1.80,2.56)	2.14 (1.86,2.53)	2.09(1.62,2.65)	0.528
Total Ccr	69.33 (58.68,84.75)	68.19 (58.74,83.48)	72.22 (56.56,89.61)	0.382
Types of peritoneal solute transport				0.019
High transport (%)	21 (9.8%)	9(6.5%)	12 (15.8%)
High average transport (%)	92 (42.8%)	56 (40.3%)	36 (47.4%)
Low average transport (%)	86 (40.0%)	65 (46.8%)	21 (27.6%)
Low transport (%)	16 (7.4%)	9 (6.5%)	7 (9.2%)
The duration of PD (months)	20 (11.00,34.50)	15.50 (9.00,27.25)	29.00 (17.00,55.00)	<0.001
PD peritonitis (%)	87 (33.9%)	39 (24.1%)	48 (50.5%)	<0.001

Note: BMI, body mass index; ESKD, end-stage kidney disease; SBP, systolic blood pressure; DBP, diastolic blood pressure; DM, diabetes mellitus; CAD, coronary artery disease; ALB, albumin; PA, prealbumin; BUN, blood urea nitrogen; Scr, serum creatinine; UA, uric acid; Ca, calcium; P, phosphorus; Hb, hemoglobin; FBG, fasting blood glucose; TG, triglyceride; TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; iPTH, intact parathormone; CAPD, continuous ambulatory peritoneal dialysis; Kt/V, urea clearance index; CCr, creatinine clearance; PD peritonitis, peritoneal dialysis-associated peritonitis.

Figure 1. Flow chart for the study. PD, peritoneal dialysis; KRT, kidney replacement therapy; HD, hemodialysis; KTx, kidney transplantation; CVD events, cardiovascular events.

Figure 2. The specific reasons for (A) Patient-oriented conversion and (B) Physician-oriented conversion.

Table 2. Odds ratios for the occurrence of physician-oriented conversion in PD patients based on logistic regression analysis.

Factor	Univariate			Multivariate^a
		OR	95% CI	P-value	OR	95% CI	P-value
Age at catheterization (years)	1.056	1.031–1.083	<0.001	1.031	1.002–1.061	0.036
BMI (kg/m^2)	1.113	1.023–1.211	0.013	1.065	0.968–1.174	0.197
History of DM	11.566	2.529–52.896	0.002	5.969	1.522–33.702	0.009
Education level	0.639	0.515–0.794	<0.001	0.723	0.558–0.929	0.011
Annual household income	0.729	0.579–0.917	0.007	0.749	0.565–0.988	0.041
ALB (g/L)	0.932	0.881–0.986	0.015	0.971	0.909–1.038	0.389
FBG (mmol/L)	1.618	1.143–2.292	0.007	–
LDL–C (mmol/L)	1.365	1.003–1.858	0.048	1.112	0.781–1.578	0.553
Unmarried*			0.010	–
Married	4.112	1.657–10.205	0.002
Divorced	3.500	0.657–18.648	0.142
High transport*			0.023	–
High average transport	0.482	0.185–1.260	0.137
Low average transport	0.242	0.090–0.655	0.005
Low transport	0.583	0.157–2.167	0.421
The duration of PD (months)	1.042	1.026–1.057	<0.001	–
PD peritonitis (%)	3.221	1.877–5.527	<0.001	–

Note: ^a Modified by using Firth regression; * comparison group; OR, Odds ratio; CI, confidence interval; BMI, body mass index; DM, diabetes mellitus; ALB, albumin; FBG, fasting blood glucose; LDL-C, low-density lipoprotein cholesterol; PD peritonitis, peritoneal dialysis-associated peritonitis.

Figure 3. Kaplan–Meier survival curves for (A) cardiovascular events and (B) all-cause mortality of patients in the patient-oriented and physician-oriented KRT conversion groups. Kaplan–Meier survival curves for (C) cardiovascular events and (D) all-cause mortality of patients converted to HD or KTx in the patient-oriented conversion group. Kaplan–Meier survival curves for (E) cardiovascular events and (F) all-cause mortality of patients converted to HD or KTx in the physician-oriented conversion group.

Table 3. The hazard ratios associated with physician-oriented conversion for cardiovascular events and all-cause mortality according to Cox regression analysis.

		Unmodified Modified^a
		HR	95% CI	P-value	HR	95% CI	P-value
Cardiovascular events
Univariate	Physician-oriented conversion	3.880	2.018–7.460	<0.001	3.818	2.034–7.463	<0.001
Multivariate	Physician–oriented conversion	2.956	1.492–5.857	0.002	2.916	1.501–5.846	0.002
	Age at catheterization	1.029	0.999–1.059	0.054	1.029	0.999–1.059	0.055
	History of DM	0.961	0.342–2.696	0.939	1.044	0.348–2.635	0.933
	ALB	0.947	0.887–1.010	0.096	0.947	0.888–1.010	0.097
All-cause mortality
Univariate	Physician–oriented conversion	4.162	1.444–11.995	0.008	3.956	1.487–11.915	0.006
Multivariate	Physician–oriented conversion	0.768	0.222–2.653	0.676	0.740	0.236–2.611	0.622
	Age at catheterization	1.040	0.989–1.094	0.123	1.039	0.990–1.091	0.124
	BMI	1.075	0.873–1.324	0.498	1.083	0.874–1.315	0.449
	The duration of PD	1.032	1.004–1.061	0.023	1.032	1.004–1.059	0.024
	Education level	0.669	0.385–1.164	0.155	0.700	0.401–1.162	0.171
	Annual household income	0.744	0.448–1.235	0.252	0.762	0.464–1.251	0.280
	History of DM	4.684	1.087–20.184	0.038	4.196	0.989–16.241	0.052
	TC	0.553	0.112–2.736	0.468	0.693	0.119–2.631	0.627
	LDL-–C	2.984	0.402–22.168	0.285	2.279	0.403–19.963	0.385

Note: ^a Modified by using Firth regression; HR, hazards ratio; CI, confidence interval; DM, diabetes mellitus; ALB, albumin; BMI, body mass index; TC, total cholesterol; LDL-C, low-density lipoprotein cholesterol.