Associations with Peritoneal Dialysis Treatment Failure in Young Adults: A Mixed-Methods Study

Background: Studies have observed fewer young adults use peritoneal dialysis (PD) compared to haemodialysis (HD). PD is associated with preservation of residual renal function and may provide more flexibility for patients. We sought to understand treatment transitions and patient experiences. Methods: A sequential explanatory mixed methods study was undertaken. Quantitative analysis utilized data from the Surveying People Experiencing young Adult Kidney failure study, which included individual treatment timelines from 1987 to 2015. Cox proportional hazards analysis examined psychosocial associations with PD failure (defined as a switch to haemodialysis). Semi-structured qualitative telephone interviews were conducted with a purposive sample of young individuals. Transcripts were analysed thematically. Results: The cohort comprised 470 participants (50% male, 85% Caucasian, mean age of 16 years). Twenty-five percent experienced PD more than once. PD survival rates at 1 and 5 years were 71% and 37% respectively. Risk associations for PD failure included young adulthood (15-19 years hazard ratio (HR) 2.41, 95% confidence intervals (CI) 1.35, 4.28; 20-24 years HR 3.39, CI 1.97, 5.83; 25-30 years HR 3.14, CI 1.65, 6.00; p<0.005, compared to 10-14 years) and primary renal disease (systemic diseases HR 1.97, CI 1.12, 3.46, p=0.02, compared with tubulointerstitial diseases). Leading causes of PD failure were infection (50%), compliance issues (21%), and mechanical problems (18%). Thirteen participants aged 14-29 during PD treatment were interviewed. They had received PD during 2013-2015, but most had received renal transplants by the interview date in 2020 so they explored their experience retrospectively. Major themes included compromised autonomy, life impact and support structures; resilience was reported by PD survivors. Conclusion: Young adulthood emerges as a high-risk period for returning to haemodialysis both from transplant failure and PD failure. Our study suggests the need for enhanced preparation including detailed information on dialysis modalities including considerations for university life, workplace environments and sexual relationships. Funding: Government Support – Non-U.S.