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Early dropout remains a major concern in peritoneal dialysis (PD), compromising technique survival and patient outcomes. Identifying baseline predictors of PD discontinuation within the first year is crucial for enhancing long-term success rates.
This retrospective study included 245 patients who initiated PD at a single tertiary center. Demographic, clinical, and laboratory data at baseline were compared between patients who continued PD and those who discontinued within one year of initiation. Variables with p<0.10 in univariate logistic regression were included in the multivariate model to identify independent predictors of first-year dropout.
During the first year, 35 patients (14%) discontinued PD. Patients who dropped out within the first year tended to have lower baseline albumin and were more frequently current smokers or treated with automated PD (Table 1). The most frequent cause was dialysis or ultrafiltration failure (34.3%), followed by death (25.7%), peritonitis (17.1%), tunnel infection (11.4%), dialysate leakage (5.7%), and other rare causes (2.9%) (Figure 1). In univariate analysis, serum albumin (p=0.046), CRP (p=0.085), PD modality (p=0.027), and smoking (p=0.039) were possible risk factors for first-year PD discontinuation. These variables were subsequently entered into the multivariate logistic regression model. Among them, baseline albumin remained the only independent predictor of early dropout (OR=0.139, 95% CI 0.032–0.614, p=0.009). Neither smoking, CRP, nor PD modality maintained significance in the adjusted model (Table 2).
Table-1: Baseline Characteristics of Patients Initiating Peritoneal Dialysis According to First-Year Dropout Status
Total
n=245
No
n=211 (86%)
Yes
n=34 (14%)
p value
Sex (female)
108 (44.1%)
96 (45.5%)
12 (35.3%)
0.26
Age (years)
45.3±16.5
45.3±16.4
45.6±17.7
0.92
BMI
24.1 (21.8-27.7)
24.6 (21.7-28.0)
23.7 (21.8-26.1)
0.16
DM
58 (23.7%)
49 (23.2%)
9 (26.5%)
0.67
HT
209 (85.3%)
181 (85.8%)
28 (82.4%)
0.60
CAD
43 (17.6%)
37 (17.5%)
6 (17.6%)
0.98
Smoking
47 (19.2%)
36 (17.1%)
11 (32.4%)
0.036
Education status
High school or above
10 (42.9%)
87 (41.2%)
18 (52.9%)
0.20
PD choice
Mandatory
26 (10.6%)
24 (11.4%)
2 (5. 9%)
0.54
Previous hernia history
33 (13.5%)
28 (13.3%)
5 (14.7%)
0.82
Laboratuary values
Hb (g/dl)
Albumin (g/dl)
PTH (pg/ml)
CRP (mg/dl)
10.5±1.7
3.7±0.6
251 (115-472)
3 (3-7)
10.5±1.6
3.8±0.6
236 (103-452)
3 (3-6.6)
10.2±1.6
3.6±0.7
317 (169-577)
5 (3-12.8)
0.09
0.15
0.06
Baseline RRF (yes)
213 (86.9%)
184 (87.2%)
29 (85.3%)
0.76
PD modality
CAPD
APD
200 (81.6%)
45 (18.4%)
177 (83.9%)
34 (16.1%)
23 (67.6%)
0.023
Assisted PD
28 (11.4%)
4 (11.8%)
0.94
Peritonitis episodes in first year, n (%)
39 (15.9%)
31 (14.7%)
8 (23.5%)
0.19
Table 2: Univariate and multivariate analysis of the risk factors for first year dropout in peritoneal dialysis patients
Univariate, OR (%95 CI)
Multivariate, OR (%95 CI)
Age
1.001 (0.979-1.023)
0.920
Sex (Male)
1.530 (0.720-3.252)
0.268
2.325 (1.041-5.190)
0.039
2.597 (0.469-14.392)
0.275
Albumin
0.542 (0.297-0.988)
0.046
0.139 (0.032-0.614)
0.009
CRP
1.052 (0.993-1.114)
0.085
1.038 (0.972-1.109)
RRF
1.687 (0.372-7.654)
0.498
PD modality (APD)
2.490 (1.111-5.579)
0.027
2.676 (0.511-14.011)
0.244
1.039 (0.337-3.205)
0.947
Approximately one in seven patients discontinued PD within the first year, most commonly due to ultrafiltration failure or infectious complications. Univariate analysis identified several potential risk factors; however, low baseline serum albumin was the sole independent predictor of dropout in multivariate analysis. These findings emphasize the prognostic significance of nutritional and inflammatory status at the initiation of PD, suggesting that early optimization of these factors may improve technique survival.
