Dialysis Modality and Mortality in the Elderly

Han, Seung Seok; Park, Sun-Hee; Kang, Suk‐Ho; Kim, Kyoung Hoon; Ryu, Dong Ryeol; Kim, Hyun‐Wook; Joo, Kwon Wook; Lim, Chun Soo; Kim, Yon Su

doi:10.2215/cjn.05160514

Cited by 84 publications

(61 citation statements)

References 40 publications

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“…In fact, in a recent meta‐analysis by Han et al, the mortality risk in elderly patients (aged ≥65 years) was significantly higher among those treated with PD compared to conventional HD. This increased risk of death was even more pronounced among those with diabetes and longer dialysis vintage . On the other hand, among younger patients (aged <65 years), PD has been shown to be associated with superior survival rates …”

Section: Survival By Modality: Specific Patient Subgroups and Interacmentioning

confidence: 99%

Dialysis modality and survival: Done to death

Trinh

Chan

Perl

2018

Seminars in Dialysis

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The debate surrounding whether peritoneal dialysis or hemodialysis is associated with differential survival continues as the numerous comparative studies over the past 3 decades have yielded conflicting results. Findings have also evolved over time in the setting of changing patient characteristics, advances in dialytic technologies, and the use of more robust statistical and epidemiologic approaches. Here, we will critically review the body of evidence, both historical and contemporary, comparing survival across dialysis modalities. Significant limitations of the observational nature of the current literature will be highlighted given that no adequately powered randomized controlled trials exist. Given the lack of consistency and limitations of current studies, coupled with the poor survival across both modalities, we can likely conclude that survival comparisons between both modalities do not appreciably differ. Hence, the choice of dialysis modality should not be dictated by survival comparisons, but rather be based on an individualized and informed decision making that places patient preference and lifestyle considerations at the forefront, while integrating medical factors and availability of resources and support. The emphasis of future research should move beyond survival outcomes when comparing dialysis modalities, and instead be redirected to patient-endorsed and patient-reported outcomes.

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Section: Survival By Modality: Specific Patient Subgroups and Interacmentioning

confidence: 99%

Dialysis modality and survival: Done to death

Trinh

Chan

Perl

2018

Seminars in Dialysis

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“…Last year, Han et al (18) published their database study of 13,065 incident PD and HD Korean patients aged $65 years, showing a hazard ratio of 1.20 (95% confidence interval, 1.13 to 1.28) for poorer survival on PD. Their metaanalysis of 631,421 elderly patients in 15 nonrandomized studies showed a hazard ratio for PD over HD of 1.10 (95% confidence interval, 1.01 to 1.20).…”

Section: The Survival Battle Begins: Pd Versus Hdmentioning

confidence: 99%

Survival by Dialysis Modality—Who Cares?

Lee

Bargman

2016

CJASN

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In light of the recent emphasis on patient-centered outcomes and quality of life for patients with kidney disease, we contend that the nephrology community should no longer fund, perform, or publish studies that compare survival by dialysis modality. These studies have become redundant; they are methodologically limited, unhelpful in practice, and therefore a waste of resources. More than two decades of these publications show similar survival between patients undergoing peritoneal dialysis and those receiving thrice-weekly conventional hemodialysis, with differences only for specific subgroups. In clinical practice, modality choice should be individualized with the aim of maximizing quality of life, patient-reported outcomes, and achieving patient-centered goals. Expected survival is often irrelevant to modality choice. Even for the younger and fitter home hemodialysis population, quality of life, not just duration of survival, is a major priority. On the other hand, increasing evidence suggests that patients with ESRD continue to experience poor quality of life because of high symptom burden, unsolved clinical problems, and unmet needs. Patients care more about how they will live instead of how long. It is our responsibility to align our research with their needs. Only by doing so can we meet the challenges of ESRD patient care in the coming decades.

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“…However, studies comparing survival statistics with ever more complex analyses continue to be published. In this issue of CJASN, Han et al (3) have published an analysis from the Korean registry with an accompanying meta-analysis focusing on the survival of older patients on hemodialysis (HD) and peritoneal dialysis (PD). In such a multimorbid cohort burdened with other geriatric syndromes, mortality outcomes on dialysis are generally poor and will depend on many factors other than dialysis modality.…”

mentioning

confidence: 99%