Objective: To study the extent and causes of the declining use of peritoneal dialysis (PD) as kidney replacement therapy in patients with end-stage renal disease in the Netherlands.
Design: Retrospective cohort study.
Method: The prevalence and incidence of various kidney replacement therapies in the Netherlands from 1995 to 2010 were analysed. Also the 5-year outflow of patients on PD or haemodialysis (HD) from 1995 to 2006 was analysed using the cumulative incidence competing risks method and Cox regression analysis.
Results: The absolute number of patients starting PD between 1995 and 2008 was stable at about 400 per year. There was a relative decline in the use of PD in the total dialysis population from 15% in 1995 to 8% in 2010. This decrease was seen in both large and small centres and was related to a relative increase in the numbers undergoing HD (67% before 2001, 74% in 2009), and kidney transplantation before dialysis (3% before 2002, 9% in 2009), as well as a decrease in change of therapy from HD to PD. The increased number starting on HD was associated with the growth of the incident patient group aged 65 years or older, most of whom (80-85%) underwent HD. Within the younger group (0-65 years) there was an increase in numbers on HD and in the number of pre-emptive transplantations.
Conclusion: The decline in the prevalence of PD was partly explained by the relative increase in numbers starting HD, associated with an ageing patient population, fewer people changing from HD to PD therapy, and the increased number of kidney transplantations before dialysis in younger patients. The increasing prevalence of HD has been made possible by growth of the HD capacity.