Beyond the Five-Year survival threshold in Peritoneal Dialysis: Public Health insights from the Moroccan experience in a Low- and Middle-Income country context

Background: Long-term survival on peritoneal dialysis (PD) remains uncommon globally and is even more challenging in low- and middle-income countries (LMICs), where resource constraints and health system factors influence dialysis outcomes. This study compared clinical, biological, and outcome differences between Moroccan patients who achieved ≥5 years of PD survival and those who did not. Methods: We conducted a retrospective descriptive and analytical study from June 2006 to January 2024 including 175 PD patients. Participants were categorized into long-term survivors (≥5 years, n=61) and non-survivors (<5 years, n=114). Demographic characteristics, comorbidities, laboratory parameters, and technique-related complications were assessed. Survival and mortality determinants were analyzed using linear and logistic regression models. Results: Female sex was significantly associated with longer PD survival (p=0.019). Non-survivors presented higher baseline urea, creatinine, and vitamin D levels, and lower bicarbonate, albumin, residual kidney function (RKF), and weekly creatinine clearance (WCC). Infectious complications—including peritonitis and catheter infections—were more frequent among non-survivors. Among long-term survivors, RKF, Kt/V, and albumin decreased over time, while hemoglobin and vitamin D improved. Cardiovascular events were the leading cause of death across both groups. Low ultrafiltration, hypoalbuminemia, and recurrent peritonitis were major predictors of mortality. Conclusion: Although uncommon, long-term PD survival is achievable in Morocco. Better preservation of RKF, higher serum albumin, and fewer infectious complications contribute to prolonged survival. Strengthening early identification and management of these modifiable factors may improve outcomes in PD programs. Enhancing PD management strategies, infection control practices, and nutritional support could significantly reduce mortality and ease the burden on health systems in LMICs where access to renal replacement therapies remains limited.