Analysis of causes and risk factors for early withdrawal from peritoneal dialysis therapy and development of a prediction nomogram.

Abstract

Objective: This study aimed to explore the causes and risk factors for early withdrawal from treatment in patients starting peritoneal dialysis (PD) and establish a prediction model.

Materials and methods: A single-center retrospective cohort study was conducted on 1,037 patients who received PD therapy at the Second Affiliated Hospital of Soochow University from January 2010 to June 2023. Demographic characteristics and laboratory examinations of the patients were collected. Binary logistic regression analysis was performed to identify risk factors for early withdrawal from PD therapy, establish a prediction model, and assess its calibration curve.

Results: In total, 84 (8.1%) of 1,037 patients withdrew early from PD therapy within the first 6 months. Primary reasons for early withdrawal included death (63.1%), conversion to hemodialysis (HD) (28.6%), and kidney transplantation (8.3%). Logistic regression analysis showed that advanced age (OR = 1.033, 95% CI: 1.014 - 1.052, p = 0.001), combined with systemic vasculitis (OR = 4.347, 95% CI: 1.455 - 12.984, p = 0.008), cardiovascular disease (OR = 1.644, 95% CI: 1.002 - 2.699, p = 0.049), and hypoalbuminemia (OR = 0.957, 95% CI: 0.919 - 0.997, p = 0.037) increased the risk of early withdrawal from PD therapy. The statistically significant parameters were included to establish a prediction model, the C-index was 0.711 (95% CI: 0.650 - 0.770).

Conclusion: The main causes of early PD withdrawal were death and conversion to HD. The main causes of death were cardiovascular diseases and infection; the main causes of conversion to HD were dialysate leakage and catheter dysfunction. Advanced age, systemic vasculitis, combined with cardiovascular disease, and hypoalbuminemia increased the risk of early withdrawal from PD therapy.