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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
Please follow the instructions below to input your abstract title.
Abstract titles should be brief and reflect the content of the abstract.
Japan faces rapid population aging, with the mean age at dialysis initiation rising to 71 years. The leading causes of dialysis initiation are diabetic nephropathy (~40%) and nephrosclerosis (~15%), indicating that over half of patients start dialysis due to arteriosclerotic diseases. Many elderly patients initiate dialysis with multiple comorbidities. Dialysis is costly and often requires frequent hospitalizations, particularly for hemodialysis (HD) patients, affecting both healthcare expenditure and patient quality of life (QOL). Although dialysis patients’ life expectancy is roughly half that of the general population, HD remains the predominant modality. It is uncertain whether patients receive accurate information in renal replacement therapy (RRT) choice consultations. To provide evidence for better life planning, we compared survival rate, infection-related hospitalization, and all-cause hospitalization across RRT modalities.
We retrospectively analyzed 280 patients who initiated preemptive kidney transplantation (PEKT), peritoneal dialysis (PD), or HD at our center between January 1, 2020, and December 31, 2024. Patients were classified by the initial modality, even if they later switched; those who did not transition from emergent to maintenance dialysis were excluded.
Study design: Retrospective observational study
Primary outcomes: Survival, PD-related peritonitis, hospitalization due to pneumonia, bloodstream infection, other infections, or non-infectious causes
Ethical approval: Yuuai Ethics Review Committee (R06R019)
Patient distribution was PEKT 28, PD 56, and HD 196. Median age at initiation was 57, 58, and 71 years, respectively, highlighting the advanced age of HD patients. Survival was highest in PEKT, followed by PD and HD. No patients ≥75 years underwent PEKT; in patients ≥75 years, 5-year survival was ~50% for both PD and HD. Infection-related hospitalization was higher in HD than PD, with PD-related peritonitis at 0.25 patient-years. Overall hospitalization risk was also higher in HD. Differences in infection-related and overall hospitalization between HD and PEKT were minimal.
Although PEKT involves risks such as infections, protocol kidney biopsies, and frequent hospitalizations for stent exchanges, its clear survival benefit outweighs these disadvantages. In patients <75 years, PD offers advantages over HD when considering infection and overall hospitalization risks. For patients ≥75 years, survival is low for both PD and HD; therefore, rather than strongly recommending dialysis initiation, it is essential to discuss treatment decisions with patients while considering infection and hospitalization risks to optimize remaining life quality.
