The relationship between the rate of decline in residual kidney function and technique failure in patients undergoing peritoneal dialysis: a retrospective cohort study
- 1Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- 2Division of Nephrology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095 Jiefang Avenue, Wuhan, Hubei China
Abstract
Background: Preservation of residual kidney function (RKF) is critical for patients undergoing peritoneal dialysis (PD). However, the relationship between the rate of RKF decline (RKF slope) and PD technique failure remains incompletely understood, and a clinically actionable threshold is lacking.
Method: This was a single-centre, retrospective cohort study that included 539 patients who underwent peritoneal dialysis catheter placement at the hospital from 1 May 2006 to 31 December 2022. The primary analysis used pre‑specified Cox models to assess the association between RKF decline rate and technique failure (death or transfer to HD). RCS analysis and Kaplan‑Meier curves were also performed.
Results: During a median follow‑up of 30 months, 152 patients (28.2%) in the full cohort experienced technique failure. The median RKF decline rate was −0.14 ml/min/1.73 m2 /month (IQR −0.20 to −0.08). Faster RKF decline was independently associated with a higher risk of technique failure (per 0.1 ml/min/1.73 m2 /month: HR = 1.19, 95% CI 1.05–1.34, p < 0.001). RCS analysis revealed a nonlinear relationship (p = 0.047) with a candidate threshold at −0.20. Patients with decline faster than −0.20 had significantly lower technique failure‑free survival (log‑rank p = 0.027).
Conclusion: There was a nonlinear relationship between the rate of decline in residual kidney function (RKF slope) and the risk of PD patients experiencing technique failure, with a candidate threshold of −0.20 ml/min/1.73 m2 /month. Regularly monitoring the decline in RKF and maintaining it above −0.20 ml/min/1.73 m2 /month may help identify patients at higher risk of technique failure, although external validation is needed.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12882-026-05210-7.
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BibTeX
@article{xu2026relationship,
title = {{The relationship between the rate of decline in residual kidney function and technique failure in patients undergoing peritoneal dialysis: a retrospective cohort study}},
author = {Yulin Xu and Xiaoqin Liu and Shuwang Ge and Ying Yao},
journal = {BMC Nephrology},
year = {2026},
month = aug,
doi = {10.1186/s12882-026-05210-7},
url = {https://doi.org/10.1186/s12882-026-05210-7},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - The relationship between the rate of decline in residual kidney function and technique failure in patients undergoing peritoneal dialysis: a retrospective cohort study
AU - Yulin Xu
AU - Xiaoqin Liu
AU - Shuwang Ge
AU - Ying Yao
PY - 2026
DA - 2026/08/04
JO - BMC Nephrology
DO - 10.1186/s12882-026-05210-7
UR - https://doi.org/10.1186/s12882-026-05210-7
AB - Background: Preservation of residual kidney function (RKF) is critical for patients undergoing peritoneal dialysis (PD). However, the relationship between the rate of RKF decline (RKF slope) and PD technique failure remains incompletely understood, and a clinically actionable threshold is lacking. Method: This was a single-centre, retrospective cohort study that included 539 patients who underwent peritoneal dialysis catheter placement at the hospital from 1 May 2006 to 31 December 2022. The primary analysis used pre‑specified Cox models to assess the association between RKF decline rate and technique failure (death or transfer to HD). RCS analysis and Kaplan‑Meier curves were also performed. Results: During a median follow‑up of 30 months, 152 patients (28.2%) in the full cohort experienced technique failure. The median RKF decline rate was −0.14 ml/min/1.73 m2 /month (IQR −0.20 to −0.08). Faster RKF decline was independently associated with a higher risk of technique failure (per 0.1 ml/min/1.73 m2 /month: HR = 1.19, 95% CI 1.05–1.34, p < 0.001). RCS analysis revealed a nonlinear relationship (p = 0.047) with a candidate threshold at −0.20. Patients with decline faster than −0.20 had significantly lower technique failure‑free survival (log‑rank p = 0.027). Conclusion: There was a nonlinear relationship between the rate of decline in residual kidney function (RKF slope) and the risk of PD patients experiencing technique failure, with a candidate threshold of −0.20 ml/min/1.73 m2 /month. Regularly monitoring the decline in RKF and maintaining it above −0.20 ml/min/1.73 m2 /month may help identify patients at higher risk of technique failure, although external validation is needed. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12882-026-05210-7.
SN - 1471-2369
ER -