A population-based approach indicates an overall higher patient mortality with peritoneal dialysis compared to hemodialysis in Korea

Abstract

To date, only a few large-scale studies have measured the effect of dialysis modality on mortality in Asian populations. Here, we sought to compare survival between incident hemodialysis (HD) and peritoneal dialysis (PD) patients using the Korean Health Insurance Review & Assessment Service database. This enabled us to perform a population-based complete survey that included 32,280 incident dialysis patients and followed them for a median of 26.5 months. To reduce biases due to nonrandomization, we first matched 7049 patient pairs with similar propensity scores. Using the log-rank test, we found the mortality rate in PD patients was significantly higher than that in HD patients. Subsequent subgroup analyses indicated that in older patients (55 years and older), with the exception of the subgroup of patients with no comorbidities and the subgroup of patients with malignancy, PD was consistently associated with a higher mortality rate. In younger patients (under 55 years), regardless of the covariates, the survival rate of PD patients was comparable to that of HD patients. Thus, while the overall mortality rate was higher in incident PD patients, mortality rates of some incident PD and HD patients were comparable in Korea.

Hemodialysis in Asia

“…A study using data from the Korean registry reported a 10-year survival of >60%. In a propensity score-matched cohort, their survival was significantly better compared to that of PD patients [58]. According to the 2003 DOPPS report, Japanese patients on dialysis enjoyed the longest survival compared to patients in other parts of the world, with 1-year crude mortality rates of 6.6% [59].…”

Association between human resources and risk of hospitalisation in end-stage renal disease outpatients receiving haemodialysis: a longitudinal cohort study using claim data during 2013–2014

“…[4][5][6] Haemodialysis is a common treatment for severe cases of CKD. According to reports by the Health Insurance Review and Assessment Service (HIRA), the number of patients who underwent haemodialysis and the associated average medical cost due to haemodialysis have rapidly increased (56 896 patients in 2009 to 69 837 in 2013; US$1.1 billion in 2009 to US$1.4 billion in 2013).…”

Disparities in Kidney Transplantation Access among Korean Patients Initiating Dialysis: A Population-Based Cohort Study Using National Health Insurance Data (2003-2013)

“…1, see www.karger.com/doi/10.1159/000450979). On the basis of a previous study using claim data in South Korea to select ESRD patients [24] , we selected the patients who had >90 days of therapy.…”

“…Comorbidities were identified by reviewing patients' medical history a year prior to the initiation of dialysis therapy. We identified diagnoses for hypertension, diabetes mellitus, cerebrovascular accident, congestive heart failure, ischemic heart disease, anemia, cancer, and glomerulonephritis by reviewing the previous literature [24] . The kidney disability was officially assessed by doctors in persons who were receiving dialysis for 3 continuous months at the time of RRT.…”