Association of nephrology referral timing with long-term survival and peritoneal dialysis-associated peritonitis in patients initiating peritoneal dialysis: a single-center retrospective study.

BACKGROUND

The timing of nephrology referral is an important determinant of outcomes in chronic kidney disease, and observational studies have examined its association with outcomes among patients initiating peritoneal dialysis (PD). We investigated whether early referral (ER) was associated with long-term survival and PD-associated peritonitis (PD peritonitis).

METHODS

We conducted a single-center, retrospective cohort study of 105 Japanese patients who initiated PD between 2007 and 2014. ER was defined as a nephrology consultation ≥ 90 days before PD initiation, and late referral (LR) as < 90 days. The primary outcome was all-cause mortality, assessed by Cox regression. The secondary outcomes were time to first PD peritonitis (Fine-Gray model) and PD peritonitis incidence rates (episodes per patient-year), compared in adjusted analyses. Follow-up continued until death, transplantation, or the end of 2020.

RESULTS

Of 105 patients (median age, 58 years; 71.4% male), 81 were in the ER group and 24 were in the LR group. During a median follow-up of 7.3 years, 42 patients (40.0%) died. ER was associated with lower mortality risk (adjusted hazard ratio, 0.43; 95% confidence interval, 0.22-0.82). PD peritonitis occurred in 54 patients (51.4%). ER was not significantly associated with time to first PD peritonitis (adjusted subdistribution hazard ratio, 0.60; 95% confidence interval, 0.33-1.07) or PD peritonitis incidence (adjusted incidence rate ratio, 0.55; 95% confidence interval, 0.29-1.05).

CONCLUSION

ER before PD initiation was associated with significantly improved long-term survival. Associations between ER and PD peritonitis outcomes did not reach statistical significance. These findings underscore the importance of timely nephrology referral in patients considered for PD.

CLINICAL TRIAL NUMBER: Not applicable.