Smoking and Low Serum Albumin Are Associated with First-Year Dropout in Peritoneal Dialysis: A Retrospective Cohort Study

Background and Objectives: Loss from peritoneal dialysis (PD) therapy occurs most frequently during the first year, yet whether hemodialysis (HD) transfer and death share the same risk factors is unclear. We examined the causes of first-year dropout and whether the factors associated with each component differ. Materials and Methods: We retrospectively studied 297 adults initiating PD. First-year dropout was defined as a composite of HD transfer or death within 12 months, with HD transfer defined as transfer to HD without return to PD within 90 days. Associations were assessed by multivariable logistic regression, and the individual components were assessed by multinomial logistic regression. Results: Dropout occurred in 33 patients (11%), including HD transfer in 8.4% and death in 2.7% (n = 8). Dialysis or ultrafiltration failure was the leading cause of HD transfer, followed by infection-related causes. Smoking was associated with dropout (OR 3.499, 95% CI 1.570–7.800), and each 1 g/dL decrease in serum albumin was associated with higher odds of dropout (OR 1.988, 95% CI 1.037–3.809). Smoking was associated with HD transfer (OR 3.447, 95% CI 1.430–8.309) and each 1 g/dL decrease in serum albumin was associated with death (OR 6.246, 95% CI 2.013–19.382). Conclusions: Smoking and lower serum albumin were associated with first-year PD dropout. The association with serum albumin was stronger for death than for HD transfer, whereas the association with smoking did not differ significantly between components, although component-specific analyses were limited by the small number of deaths. Assessment of smoking status and serum albumin at PD initiation may help identify patients at increased risk.