Parametric methods for estimating survival in continuous ambulatory peritoneal dialysis patients in the presence of competing events

Abstract

Background & Aim: In many studies, the survival of patients with chronic kidney disease who are treated with peritoneal dialysis technique has been considered, while this is possible in peritoneal dialysis  patients  to switch  to another  treatment.  To achieve  more  accurate  estimation  of patient survival is necessary to examine all events. The purpose of this study is to estimate the cumulative incidence function (CIF) of events using competing risks method and then calculating the survival of patients treated with peritoneal dialysis.
Methods  & Materials:  This study includes  417 patients  with chronic  kidney disease who were under peritoneal  dialysis between  July 1996 and December  2009 in three centers in Tehran. We achieved their survival by 13 years follow-up time. We have collected patient demographic data and clinical characteristics. CIF of death and other events was estimated using the cause-specific hazard approach  and  direct  approach. Parametric  regression  model  was  used  to  adjust  the  effects  of covariates. The data analysis was performed using the R software.
Results: In this study, the median follow-up time was 664 days. A total of 112 (26.9%) patients treated with peritoneal dialysis died before completing the study, and before the end of the study. One hundred  sixty seven  (40.0%)  patients  treated  with peritoneal  dialysis  changed  their dialysis method to hemodialysis or had renal transplantation .
Conclusion: The effective risk factors on death CIF and other competing events CIF were diabetes mellitus, albumin,  creatinine,  diastolic  blood  pressure,  urea  and  age,  creatinine,  diastolic  blood pressure, respectively.