Comparative study of peritoneal dialysis versus hemodialysis on the clinical outcomes in Korea: a population-based approach

Abstract

There has been paucity of data regarding the secular trend of adverse outcomes in peritoneal dialysis (PD) as compared with hemodialysis (HD) in Korea. 96,596 patients who started dialysis between 2004–2015 in Korea were identified using the National Health Insurance Service database. The adjusted hazard ratio (HR) (95% confidence interval, CI) of PD over HD for mortality was 1.31 (1.27–1.36; P < 0.001) in the period of 2004–2007 and 1.21 (1.16–1.27; P < 0.001) in the period of 2008–2011. However, the hazard of PD over HD for mortality turned out to be insignificant in the period of 2012–2015. Similar trend was noted for nonfatal cardiovascular events (CVEs). In subgroup analysis, the hazard of PD over HD for mortality was evident, regardless of the status of age, diabetes, and comorbidity burden in 2004–2011. In 2012–2015, however, the hazard of PD over HD for mortality was insignificant when follow up was censored at one year, which became significant when follow up follow up was censored at three or five year. In conclusion, the mortality of PD over HD in Korea has been significantly improved, a finding that was paralleled by the improved nonfatal CVEs.

Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies

“…Among the studies being removed, seven studies reported RR only [14][15][16][17][18][19][20], four were reduplicative cohort study [21][22][23][24], one was randomized clinical trial [4], the remain were excluded for other causes, such as no comparison groups, no relevant outcomes or no results of interest reported. Finally, a total of 17 studies were included in our analyses [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41].…”

“…The characteristics of the studies and basic information of the subjects were listed in Table 1. Among them, four studies were from North America [33,35,37,41], six from Europe [26,27,31,32,36,39], six from Asia [25,[28][29][30]38,40], and one from Oceania [34]. The studies were published between 2007 and 2019 and included a total of 504 304 dialysis patients among whom 62 462 patients were treated with peritoneal dialysis, 441 842 patients underwent hemodialysis.…”

“…A total of 14 studies using an intention-to-treat framework were included in the analysis [25][26][27][28][29][30][31][32]35,36,[38][39][40][41]. The comparison showed the overall HR was 1.23 with 95% CI (1.13 to 1.34).…”

Changes in mortality hazard of the Korean long-term dialysis population: The dependencies of time and modality switch

“…32 Recent publication showed that the improved patient survival of PD accompanied less cardiovascular comorbidity burden, albeit the total number of PD is decreased in later period. 33 In the present study, we focused on the changing pattern of mortality hazard and HR even in the previously noted worse prognosis populations. It is an interesting phenomenon that the mortality HR of the PD group reverted to low in the long-term follow-up, especially in the traditional high-risk groups (diabetic ESRD and elderly).…”

“…32 Recent publication showed that the improved patient survival of PD accompanied less cardiovascular comorbidity burden, albeit the total number of PD is decreased in later period. 33 In the present study, we focused on the changing pattern of Figure 5. Time-varying hazard ratios between the PD and HD groups across different subgroups: (a) male, (b) non-DM, (c) age <65 years, (d) female, (e) DM, and (f) age 65 years.…”