Survival Outcomes and Mortality Risk Factors in Peritoneal Dialysis

Background Peritoneal dialysis (PD) is a widely used renal replacement modality, yet long-term survival remains suboptimal, especially in resource-constrained settings. This study aimed to assess survival rates and associated clinical and socioeconomic factors among patients on PD at a tertiary care center in South India. Materials and Methods We retrospectively analyzed 428 patients initiated on PD between January 2012 and December 2023. Baseline demographic, clinical, and socioeconomic variables were collected. Survival outcomes were assessed using Kaplan-Meier curves, and predictors of mortality were analyzed using Cox proportional hazards models. Results The median follow-up was 21.5 months (IQR: 11.8–39.6). The mean age at initiation was 51.6 ± 14.5 years, and 67.5% were male. Survival rates at 1, 2, 3, and 5 years were 86.4%, 67.0%, 56.5%, and 31.8%, respectively. On multivariable analysis, independent predictors of mortality included diabetes mellitus (hazard ratio, 1.98; P = 0.014), diabetic kidney disease, hypoalbuminemia (hazard ratio, 1.446; P = 0.010), and cerebrovascular disease (hazard ratio, 1.738; P = 0.015). Insurance coverage was associated with a significantly lower risk of death (hazard ratio, 0.396; P < 0.0001). Cardiovascular disease accounted for most known deaths (32.1%), followed by infection-related complications. Patients who initiated dialysis directly with PD had superior survival outcomes compared to those who transitioned from hemodialysis (HD). Limitations include the retrospective, single-center design and missing data on key variables such as residual renal function and precise causes of death. Conclusion Mortality among Indian PD patients is driven by atherovascular and metabolic comorbidities, malnutrition, and socioeconomic factors. Our findings highlight the need for early referral, optimal cardiovascular disease management and greater financial support to improve outcomes in PD programs across India.