Trends in peritoneal dialysis demographics, peritonitis and HD transfer in Australia from 2013-2022.

BackgroundThe proportion of dialysis patients performing PD in Australia is decreasing over time.1 Understanding the trends in population, the rates and causes of peritonitis and haemodialysis (HD) transfer over time is critical towards understanding this trend.MethodsStudy Design: Registry-based cohort study using Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry data. Inclusion criteria: All Australian patients starting PD older than 18 years, starting PD within 90 days of KRT entry from 1 January 2013 through 31 December 2022.AnalysisPeritonitis rates were analysed using Poisson regression, while time to first peritonitis and HD transfer were assessed using Cox Proportional Hazards and competing-risks regression models.ResultsThe demographic profile of PD patients has remained relatively stable. Peritonitis rates declined from 0.40 to 0.33 infections per patient-year between 2013 and 2022. Over time, peritonitis-associated HD transfer reduced, HR 0.96 [95% CI: 0.93-0.98], p < .001. Despite this, there was a deterioration in overall HD transfer, HR 1.03 [95% CI: 1.02-1.04] per year, p < .001 and worse adjusted non-infective HD transfer HR 1.02 [95% CI: 1.01-1.04] per year, p = .006.ConclusionPD utilisation in Australia has declined over the past decade, despite improvements in peritonitis rates and peritonitis-associated HD transfer. The demographic profile of PD patients has remained relatively stable, suggesting systemic rather than patient-level factors are driving these trends. The apparent disconnect between infection control improvements and overall HD transfer highlights the growing importance of non-infective contributors such as access, psychosocial factors, and clinical support.