Peritoneal Dialysis in Young Adults: A Mixed-Methods Study

Background
Peritoneal dialysis (PD) preserves kidney function and offers flexibility; however, few young adults have it compared with hemodialysis (HD). This study aimed to understand factors influencing the change from PD to HD.

Study Design
This was a sequential explanatory mixed-methods study.

Setting & Participants
Quantitative data were collected from 470 participants (50% male participants, 85% White, mean age: 16 years) who received dialysis between 1987 and 2015. Cox proportional hazards analysis was used to examine psychosocial factors associated with transitions from PD to HD. Qualitative data were gathered from 13 young adults (aged 14-29 years) who received dialysis between 2013 and 2015, with retrospective interviews conducted in 2020.

Results
25% of participants experienced multiple episodes of PD. Survival rates for PD at 1 and 5 years were 71% and 37%, respectively. Risk factors for transitioning to HD included young adulthood (age: 15-30 years), with higher transition risks in older age groups (age: 15-19 years, HR: 2.41; age: 20-24years, HR: 3.39; age: 25-30 years, HR: 3.14; P<0.005). Other factors included primary kidney disease type (systemic diseases vs tubulointerstitial diseases). Leading causes for transition were infection (50%), noncompliance (21%), and mechanical issues (18%). Qualitative analysis revealed the key themes around communicating treatment options, life impact, and support structures. Resilience was an additional theme among those who continued PD.

Limitations
The study was based on cross-sectional psychosocial data, lacked detailed parental involvement, and may have suffered recall bias.

Conclusions
Young adults are at higher risk of transitioning to HD owing to both transplant failure and complications with PD. Challenges of PD have been underestimated, and there is a need to educate young adults well on all dialysis options. Additional support including mental health support, peer support, and support during life changes, such as moving out of their family home, is recommended.

Plain-Language Summary
This study aimed to understand why young adults are more likely to switch from peritoneal dialysis (PD) to hemodialysis. Although PD preserves kidney function and offers flexibility, few young adults choose it. We conducted a mixed-methods study with 470 patients aged 0-30 years and interviews with 13 individuals who were receiving dialysis. Our findings showed that young adults (aged 15-30 years) were at higher risk of transitioning to hemodialysis, mainly owing to infections, noncompliance, and mechanical issues. Challenges of PD have been underestimated, and there is a need to educate young adults well on all dialysis options. Additional support including mental health support, peer support, and support during life changes, such as moving out of their family home, is recommended.