Comparison of Mortality of ESRD Patients with Lupus by Initial Dialysis Modality

Abstract

Background and objectives Little is known regarding whether mortality among ESRD patients with SLE differs between those initiating with peritoneal dialysis (PD) versus hemodialysis (HD). This study compared the mortality risk of ESRD patients with SLE initiating with PD versus HD after matching their baseline sociodemographic and clinical factors.Design, setting, participants, & measurements Of 11,023 ESRD patients with SLE initiating dialysis with PD or HD between 1995 and 2006 with complete records in the US Renal Data System, 1352 pairs were matched on 13 predictors utilizing a predicted probability of group membership into the PD group using propensity score matching. The primary outcome was overall mortality. Secondary outcomes were cardiovascular-related and infection-related mortality. Outcomes were compared between groups with survival statistics. The period of observation ended on December 31, 2009. The median follow-up was 3 years.Results Matched pairs were predominantly women (86%) with a median age of 39 years. Matched pairs had a balance (P$0.05) of all baseline factors. Matched pairs had a similar risk of overall mortality (hazard ratio, 0.96 [95% confidence interval, 0.82 to 1.13]; mortality, 21.4% [290 to 1352] versus 22.5% [304 to 1352] for PD versus HD) within the first 3 years of observation. Matched pairs also had similar cardiovascular-related mortality (10.5% versus 9.5% for PD versus HD) and infection-related mortality (3% versus 4.4% for PD versus HD).Conclusions In ESRD patients with SLE, the mortality was similar among those initiating with PD versus HD after predictors were matched between groups.

Outcome of polycystic kidney disease patients on peritoneal dialysis: Systematic review of literature and meta-analysis

“…PD treatment offers numerous advantages [ 22 , 23 ], however only 7 to 10% of end-stage renal disease patients are treated with PD [ 2 ]. This reflects, at least in part, the clinicians’ fear of technical failure [ 24 ].…”

Systematic review and meta-analysis of clinical outcomes comparison between different initial dialysis modalities in end-stage renal disease patients due to lupus nephritis prior to renal transplantation

“…From 16 ultimately eligible studies, 15,636 patients were diagnosed to have LN-ESRD prior to renal transplantation. Of 15,636 patients, 4616 were on hemodialysis and 2089 were on peritoneal dialysis, 280 directly underwent kidney transplantation, 8319 were eliminated in 1 study [24] after matching participants utilizing propensity scores by the primary author and for 332 participants details were not reported [16]. All 16 studies reported 1 or more outcomes of interest.…”

“…A total of 5 studies were conducted in Taiwan [19,[21][22][23]38], 3 in the United States of America (USA) [20,24,31], 1 in China [32], UK, Australia, France, Croatia, Brazil, and 2 in South Korea [13,36]. All studies were retrospectively conducted studies while 2 [22,38] were prospectively conducted.…”

“…In terms of SLE disease activity and morbidity, a few publications available have concluded conflicting results when comparing hemodialysis versus peritoneal dialysis as initial RRT modalities prior to renal transplantation in LN-ESRD patients. Tsai [19] opposed by Krane [20], reported more SLE disease activity in hemodialysis patients than in peritoneal dialysis, Chang [21] opposed by Kang [13], reported higher risk of infections in hemodialysis than peritoneal dialysis patients, Tsai [19] opposed by Weng [22], reported a higher risk of allcause cardiovascular events in hemodialysis than peritoneal dialysis and Wu [23] opposed by Contreras [24], reported a higher risk of mortality in hemodialysis than in peritoneal group. Ntatsaki et al [16] in a large study reported similar risks of mortality between the groups.…”

Recomendaciones sobre el manejo del compromiso renal del lupus eritematoso sistémico: Documento de Consenso de las Sociedades Chilenas de Nefrología y Reumatología

“…Son aceptables tanto hemodiálisis como peritoneodiálisis y trasplante renal 32,33 . En lupus activos con inmunosupresión se ha observado mayor incidencia de infecciones con peritoneodiálisis que con hemodiálisis, favoreciendo esta última con accesos vasculares adecuados.…”