Peritoneal dialysis therapy is a viable dialysis option for anuric patients: A retrospective cohort study

Abstract

Introduction

Compared to conventional, maintenance hemodialysis, peritoneal dialysis (PD) better preserves residual kidney function (RKF) in patients with kidney failure. However, few studies have investigated long-term prognosis of PD patients with anuria. This study aimed to investigate the long-term outcomes of anuric PD patients.

Methods

In this retrospective single-center cohort study, we included patients who received continuous ambulatory peritoneal dialysis (CAPD) and developed anuria between 2006 to 2020. The primary outcome was all-cause mortality. Secondary outcomes included technique survival and cardiovascular (CV) mortality. Cox proportional hazards regression, competing risk analysis, and subgroup analyses were performed to identify prognostic factors.

Results

A total of 615 anuric CAPD patients were included in the study, with a mean age of 47.8 ± 14.8 years at the onset of anuria. Prior to anuria onset, patients had received PD for a mean of 30.5 ± 23.0 months; following anuria onset, the median follow-up time was 40.3 months (interquartile range, 23.8–68.3). The 5- and 10-year patient survival rates following anuria onset were 68.2% and 37.1%, respectively, with corresponding technique survival rates of 75.4% and 50.6%. Cox regression analysis identified older age (cause-specific hazard ratio (cHR) 1.05; 95% confidence interval (CI) 1.04–1.06), lower serum albumin (cHR 0.97; 95% CI 0.94–1.00), diabetes (cHR 1.74; 95% CI 1.27–2.39), and cardiovascular disease (cHR 1.64; 95% CI 1.15–2.34) as independent predictors of all-cause mortality. Competing risk analysis revealed that higher glucose exposure (per 30 g/day increase) (subdistribution HR (sHR) 1.24; 95% CI 1.06–1.46) and peritonitis episodes (sHR 1.82; 95% CI 1.31–2.55) were independently associated with technique survival. Subgroup analyses revealed that the adverse prognostic effect of diabetes on all-cause mortality was more pronounced in patients aged <65 years than in those aged ≥65 years (P for interaction = 0.019).

Conclusions

This study demonstrates that PD patients who developed anuria can still achieve favorable long-term clinical outcomes, with a 5-year patient survival exceeding 68% and technique survival rates above 75%. These findings support the continued use of PD as a viable dialysis modality even after complete loss of RKF.