ORIGINAL ARTICLE Predictors of technique failure and mortality on peritoneal dialysis: An analysis of New Zealand peritoneal dialysis registry data Ashik Hayat 1 | Walaa Saweirs 2 1 Department of Medicine and Nephrology Taranaki District Health Board, University of the Auckland, Auckland, New Zealand 2 Department of Nephrology Northland District Health Board, University of the Auckland, Auckland, New Zealand Correspondence Dr. Ashik Hayat, Department of Medicine and Nephrology Taranaki Base Hospital New Plymouth Taranaki and Senior lecturer University of the Auckland New Zealand. Email: ashik.hayat@tdhb.org.nz Abstract Aim: Technique failure is a major disadvantage associated with peritoneal dialysis (PD). This study aimed to analyse the demographic and risk predictors of technique failure and mortality in patients on PD. Methods: All incidental PD patients registered on the New Zealand Peritoneal dialy- sis registry (NZPDR) from January 1995 to December 2014 were included in the study. The primary outcomes were time to technique failure and its specific causes, while as the secondary outcome was time to death. Risk predictors of technique fail- ure and mortality were analysed using multivariate Cox proportional hazards (PH) regression model. Besides, competitive risk regression analysis was undertaken to analyse the effect of death as a competing event to technique failure. Results: Of 6379 patients, there were 2993 (46.9%) episodes of technique failure and 2684 (42%) deaths. The crude technique failure and mortality rates were 165 ± 5.90 and 147.9 ± 5.50 (mean ± SD)/1000 patient-years, respectively. Hazards of technique failure were lower in older individuals above 60 years, HR 0.72 (95% CI 0.67-0.79), larger centres, HR 0.89 (95% CI 0.79-1.00) and higher with coiled cathe- ters, HR 1.26 (95% CI 1.16-1.37). Early nephrology referral, continuous ambulatory peritoneal dialysis (CAPD) and Asian ethnicities were associated with better tech- nique survival. Infections were the major cause of technique failure (58.4%) with peri- tonitis being the leading cause (30.2%). Conclusion: There are multiple factors associated with risk of technique failure, therefore it is persuasive to construct a mathematical model for early prediction, for a planned transition to HD. KEYWORDS clinical nephrology, dialysis, end-stage kidney disease Peritoneal dialysis (PD) is equivalent to haemodialysis (HD) as a treat- ment option in patients with end-stage kidney disease (ESKD). The major advantages of PD include preservation of residual kidney func- tions, treatment-related flexibility, superior patient satisfaction and a reduced risk of transmission of blood-borne infections. PD is also cost-effective with an annual cost savings of up to 40% compared to in-centre HD. 1-4 Despite these advantages, the major concerns with PD are progressive attrition in patient numbers due to technique fail- ure, resulting in significant patient risks and health care costs. 5,6 There are inconsistencies among various studies regarding the definition and timing of PD technique failure resulting in significant variability in the outcomes. 7 A comprehensive registry-based study from Australia Received: 1 September 2020 Revised: 26 October 2020 Accepted: 19 November 2020 DOI: 10.1111/nep.13837 Nephrology. 2020;1–11. wileyonlinelibrary.com/journal/nep © 2020 Asian Pacific Society of Nephrology 1