Risk of Mortality Post Switch from PD to HD: The INTEGRATED Group

Principal investigator: 
Kitty Jager

There is not much existing information describing what happens to patients after transferring from peritoneal dialysis (PD) to in-centre haemodialysis (ICHD). In medical studies that have examined transitions from one state to another, this is often a high-risk period, and there is a suggestion that this may also be true for a switch from PD to HD. The INTEGRATED group is an international group strongly linked to well-established renal registries formed to examine these periods of increased risk in patients on renal replacement therapy, which will initially focus on the PD to ICHD switch.

Within Europe, the ERA-EDTA registry will be used to describe the risk of death during the period immediately after a PD to ICHD switch, risk factors identified, and results compared with identical analyses from registries covering Australia/New Zealand, the US, and Canada. As a major contributor to the ERA-EDTA registry, this will include UKRR data. Individual registries (ERA-EDTA Registry for Europe) will conduct further analyses using data specific to that registry e.g. ANZDATA collects detail not held elsewhere on the reason for the switch from PD to ICHD, to provide further insight.

The output from this will identify the level of increased risk after a switch from PD to ICHD, how long this increased risk lasts, and which groups of patients are at highest risk. This will be complemented by an international study of the patient experience of this period. Together, they will determine the need for (or lack of) further effort to minimise this risk. It will also inform patient information on the risk associated with switching dialysis modality during shared decision making.

Simon Davies, Wim van Biesen, Anneke Kramer, Nidhi Sukul, Purna Mukhopadhyay, Ronald Pisoni, Doug Schaubel, Rajiv Saran, Bruce Robinson, David Johnson, Annie-Claire Nadeau-Fredette, Stephen McDonald, Christopher Chan, Jeff Perl, Jim Sloand


NICE accredited clinical practice guidelines 

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Analyses about the care provided to patients at UK renal centres.

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