Aim: We aimed to identify factors influencing dialysis withdrawal following modality change from peritoneal dialysis (PD) to haemodialysis (HD) using the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) between 2004-2019.

Background: Dialysis modality change is a frequent occurrence among patients on PD. Death attributed to dialysis withdrawal following a transition to HD is an under-researched area and this transition point may represent an opportunity for earlier engagement with palliative and supportive care.

Methods: Utilising the ANZDATA registry, which collects patient data from all renal units across Australia and New Zealand, we performed a retrospective observational cohort study to identify the risk factors for dialysis withdrawal following a switch from PD to HD. We included all adult patients (>18 years old) who initiated PD in Australia and New Zealand between 2004-2019 and subsequently transitioned to HD. The primary outcome was death attributable to HD withdrawal.

Results: We identified a total of 6342 patients who met inclusion criteria; of these, 1245 (19.6%) died following dialysis withdrawal. The survival probability of the dialysis withdrawal group was much lower: 0.67 versus 0.81 for death due to other causes at one year. We found that older age at PD initiation (subhazard ratio [SHR] 4.25, 95% confidence interval [CI] 2.97 – 6.06), the presence of a comorbidity, and remoteness of residence (SHR 1.22, 95% CI 1.06 – 1.40) were predictive of death due to dialysis withdrawal following modality change. 

Conclusion: Being able to recognise vulnerable patients at risk of dialysis withdrawal following a switch to HD from PD may facilitate greater shared decision-making during this transition period, prompting discussions regarding the most appropriate future pathway and opening other avenues for additional support, including early referral to palliative care.