Been mullin’ over the comment in my last dialysis team meeting that I may have to start Hemo of some form in the near future because PD, at some point, wears out. I accept this statement as a fact, but it bears validation.
As per usual, I turned to Perplexity with the following Prompt and results. Spoiler again: not so soon, it seems.
Prompt: 86-year-old male. went on PD Aug 28, 2022. What’s the probability i will need to go on HHD by the end of 2026?
Based on available data, the probability that an 86-year-old male who started peritoneal dialysis (PD) on August 28, 2022, will need to switch to hemodialysis (HD) by the end of 2026 is relatively low, but not negligible. The main reasons elderly patients on PD switch to HD are peritonitis, sepsis, or inadequate dialysis123.
Technique Survival Rates (Probability of Staying on PD)
- 1-year technique survival: 94.8–97.9%
- 2-year technique survival: 90.6%
- 3-year technique survival: 81.5–85.3%
- 4-year technique survival: 71%
- 5-year technique survival: 71.7% (in one study)12
These rates mean that, on average, about 70–80% of elderly patients who start PD are still on PD (not switched to HD) at 3–4 years after initiation. Your timeline (from August 2022 to end of 2026) is just over 4 years.
Risk Factors for Needing to Switch to HD
- Peritonitis and/or sepsis are the most common causes for switching from PD to HD in elderly patients12.
- Inadequate dialysis is another important reason1.
- Advanced age, comorbid diseases, low albumin, and low urine output at PD initiation increase risk of complications and mortality, but not necessarily technique failure134.
- Technique survival (the probability of remaining on PD) is not significantly affected by age alone in most studies4.
Mortality vs. Technique Failure
- Mortality rates are high in elderly PD patients; survival rates at 3 years are around 50%, and at 5 years drop to 17–36% for those over 751235.
- Most elderly patients who leave PD do so because of death, not technique failure (i.e., not because they need to switch to HD)23.
Summary Table: Probability of Remaining on PD
| Years on PD | Technique Survival Rate (Elderly) | Probability of Needing HD (Cumulative) |
|---|---|---|
| 1 | 95–98% | 2–5% |
| 2 | 91% | 9% |
| 3 | 82–85% | 15–18% |
| 4 | 71% | 29% |
| 5 | 71–72% | 28–29% |
Estimates based on studies of elderly PD patients, most of whom are younger than 86, so your personal risk may be slightly higher due to advanced age123.
Conclusion
By the end of 2026 (a little over 4 years on PD), the probability that you will need to switch to HD is roughly 25–30%. The majority of elderly patients who leave PD do so because of death, not technique failure. Your individual risk may be higher if you have frequent peritonitis, low albumin, or significant comorbidities1234.
If you have been stable on PD so far, your chance of needing to switch to HD by the end of 2026 is less than one in three, but ongoing monitoring and good infection prevention are very important12.
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4449459/
- https://indianjnephrol.org/clinical-characteristics-patient-and-technique-survival-in-elderly-patients-on-peritoneal-dialysis/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10557534/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8824377/
- https://www.renalfellow.org/2018/09/19/what-are-survival-rates-for-dialysis-patients/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC2649113/
- https://med.stanford.edu/news/all-news/2024/08/dialysis-older.html
- https://www.asn-online.org/education/distancelearning/curricula/geriatrics/Chapter20.pdf
- https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2730766
- https://journals.lww.com/md-journal/fulltext/2018/08310/peritoneal_dialysis_in_older_adults__evaluation_of.23.aspx
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