Evolving Comorbidity Burden and Clinical Characteristics in Peritoneal Dialysis: A 17-Year Nationwide Study

Rationale & Objective: Peritoneal dialysis (PD) is a home-based kidney replacement therapy for patients with kidney failure associated with numerous benefits, but it remains underused.As chronic kidney disease becomes a growing public health concern, understanding the evolving clinical profile of PD patients is essential.There is limited information available on the temporal trends in patients' comorbidities within this population.The study aimed to describe changes in the prevalence of comorbidities among PD patients. Study Design:We conducted a retrospective multicenter study. Setting & Participants:We used data from the French Peritoneal Dialysis Registry, including 15,982 patients who initiated PD in France between 2002, and 2018. Exposure(s) or predictor(s):Calendar year of PD initiation. Outcome(s):Prevalence of high comorbidity burden, clinical profile, and care delivery characteristics at PD initiation. Analytical Approach:We aimed to assess temporal trends in outcomes of interest among incident PD patients using Cox regression models with robust variance estimation, adjusting for confounders identified through directed acyclic graphs, and accounting for potential nonlinear effects of PD start year. Results:The proportion of patients over 85 years increased over time (Prevalence Ratio (PR) 1.44, 95% CI: 1.25-1.67),as did diabetes prevalence (PR 1.16, 95% CI: 1.08-1.25).Conversely, the proportion of patients with CCI 2 declined (PR 0.89, 95% CI: 0.85-0.94),as did those requiring assistance (PR 0.90, 95% CI: 0.85-0.95) and those considered ineligible for a kidney transplantation (PR 0.63, 95% CI: 0.60-0.66). J o u r n a l P r e -p r o o fLimitations: The retrospective design limited causal inference and the CCI may not capture all health dimensions relevant to PD patients. Conclusions:The proportion of diabetes and older patients increased over time, whereas the Charlson Comorbidity Index, the proportion of patients uneligible for a kidney transplantation and the requirement of assistance decreased, reflecting an evolving profile of PD patients.