Changing prognostic significance of peritoneal transport status in contemporary incident peritoneal dialysis patients

Abstract Background High peritoneal transport status has traditionally been linked to adverse outcomes in peritoneal dialysis (PD). However, its clinical relevance in contemporary, individualized PD practice remains unclear. We therefore evaluated its association with long-term outcomes across three successive treatment eras. Methods We conducted a retrospective cohort study of 473 incident PD patients treated between 2000 and 2024, grouped into three treatment eras reflecting major changes in PD practice. Baseline peritoneal transport status was defined by the 4-hour dialysate-to-plasma creatinine ratio and categorized as high or non-high. The primary outcome was technique failure. Fine–Gray competing-risk models were used to assess technique failure and all-cause mortality, including transport-by-era interaction terms. Results Of these, 114 (24.1%) were classified as high transporters. In the earliest era, high transport status was associated with nearly twofold higher crude technique failure rates than non-high status, but this difference narrowed over time and was minimal in the most recent era. In fully adjusted competing-risk models, high transport status was not independently associated with technique failure; instead, more recent treatment era and higher serum albumin were associated with lower risk of technique failure. A significant transport-by-era interaction suggested attenuation of the adverse prognostic impact of high transport status in contemporary practice (P for interaction = 0.044). More recent treatment era was also associated with lower all-cause mortality, whereas the transport-by-era interaction was not significant for mortality. Conclusion The prognostic significance of high peritoneal transport status appears to be era-dependent and less pronounced in contemporary PD practice. These findings suggest that PET-derived transport status may be better interpreted as a guide for individualized PD prescription rather than as a fixed predictor of adverse outcome.