Is assisted peritoneal dialysis associated with technique survival when competing events are considered?

BACKGROUND AND OBJECTIVES This study assessed whether assisted peritoneal dialysis (PD) was associated with a lower risk for technique failure using methods developed for survival analysis in the presence of competing risks. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This retrospective cohort study, based on data from the French Language Peritoneal Dialysis Registry, analyzed 9822 incident patients starting PD between January 2002 and December 2010. The observation period ended on June 1, 2011. Time to transfer to hemodialysis was compared between patients with assisted PD and those undergoing self-care PD. RESULTS There were 5286 patients undergoing assisted PD; 4230 of these were assisted by a community nurse and 1056 by family. Assisted PD patients were older and had a higher Charlson comorbidity index than self-care PD patients. There were 7594 events: 3495 deaths, 2464 transfers to hemodialysis, 1489 renal transplantations, and 146 renal function recoveries. According to a Cox model, assistance and center size were associated with a lower risk for technique failure, whereas hemodialysis before PD, early peritonitis, and transplantation failure were associated with a higher risk for transfer to hemodialysis. A Fine and Gray regression model showed that assisted PD was associated with a lower risk for transfer to hemodialysis. CONCLUSIONS Compared with patients undergoing self-care PD, those with assisted PD had a lower risk for transfer to hemodialysis, a higher risk for death, and a lower risk for transplantation.