Addressing Medical and Socioeconomic Challenges may improve Survival in Peritoneal Dialysis Patients: Study

Because global mortality predictors for peritoneal dialysis (PD) often fail to translate to Indian patients due to unique healthcare and socioeconomic disparities, Thangavel and colleagues at Christian Medical College in Tamil Nadu assessed regional survival rates and localized risk factors to address this evidence gap.

Therefore, to assess all-cause mortality and survival predictors, the 10-year retrospective study analyzed 428 adult peritoneal dialysis (PD) patients at a South Indian tertiary center. Minors, patients without renal indications, and those with less than three months of follow-up were excluded, ensuring a highly focused clinical analysis over a median follow-up of 21.5 months.

Key Clinical Findings of the Study Includes:

• Survival Trajectories: Investigators found that cumulative patient survival steadily declined over time, dropping from 86.4% at one year to 56.5% at three years and 31.8% at five years.

• Comorbidity Risks: Researchers demonstrated that the presence of diabetes mellitus and cerebrovascular disease nearly doubled the mortality risk, with hazard ratios (HR) of 1.98 and 1.738, respectively.

• Nutritional Impact: Scientists highlighted that hypoalbuminemia significantly compromised patient longevity, increasing the risk of death by an HR of 1.446 compared to patients with normal albumin levels.

• Financial Protection: Authors revealed that robust insurance coverage acted as a profound protective factor, correlating with a roughly 60% lower risk of mortality compared to self-funded patients.

• Primary Causes of Death: Clinicians noted that among identifiable causes, cardiovascular events were the leading driver of mortality at 32.1%, followed closely by sepsis from non-dialysis infections.

The results suggest that mitigating metabolic and atherovascular comorbidities, alongside proactively addressing the severely elevated risk faced by uninsured patients, is essential for improving the overall 56.5% three-year survival rate observed in this specific clinical population.

Thus, the study concludes healthcare professionals to prioritize early nephrology referrals, proactive cardiovascular management, and the integration of financial support counseling to holistically enhance long-term patient outcomes on continuous therapy.

While the single-center retrospective design and missing data on specific causes of death limit broad generalization, these nuances beautifully pave the way for future multicenter registries and targeted interventional trials to further optimize care for high-risk demographic groups.

Reference

Thangavel J, Mishra U, Balusamy D, Lalwani M, Johny J, Mani SSR, et al. Survival Outcomes and Mortality Risk Factors in Peritoneal Dialysis. Indian Journal of Nephrology. 2026 Apr 25.