Dialysis modality and survival: Done to death

Abstract

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.

Phosphate clearance in peritoneal dialysis

“…However, it is important to note that the characteristics of patients in the individual therapies differed, perhaps as a consequence of selection biases with subgroups of patients being directed to what appeared to be the most appropriate therapies for them. We agree with Trinh et al that "modalities are as different as are the patients who choose them" 32 . Consequently, the differences in phosphate removal and serum phosphate between the different investigated PD modalities reported in our study cannot be used to conclusively determine which dialysis method is better or worse.…”

Icodextrin Versus Glucose Solutions for the Once-Daily Long Dwell in Peritoneal Dialysis: An Enriched Systematic Review and Meta-analysis of Randomized Controlled Trials

“…The following databases were systematically searched from inception to November 2018: Medline (via PubMed), Embase, CENTRAL, Ichushi Web, and Chinese databases (China National Knowledge Infrastructure, 52 Chongqing, 53 Wanfang Data, 54 HK government library, 55 Hyread, 56 Ericdata, 57 National Digital Library of Theses and Dissertations in Taiwan, 4 Taiwan Journal Papers Index System, 5 TAO Taiwan Academic Online, 6 and Ariti Library 7 ). Clinical trials registries were searched to identify ongoing and recently completed studies (ClinicalTrials.gov, International Clinical Trials Registry Platform, EU Clinical Trials Register, Japan registries network, and China's Clinical Trial Registry; Table S1).…”

Increasing Peritoneal Dialysis Use in Response to the COVID-19 Pandemic: Will It Go Viral?

“…In the United States and most high-income countries, dialysis is predominantly delivered as in-center hemodialysis, although the minority of patients who undergo dialysis at home, either as home hemodialysis or peritoneal dialysis (PD), have comparable, if not better, outcomes. 1 Frequent, routine trips for dialysis treatments at health care facilities, where individuals with advanced age, a large comorbidity burden, and high rates of hospitalization are cohorted together, foster a high-risk situation for COVID-19 transmission and related morbidity and mortality. COVID-19 outbreaks across hemodialysis facilities have been described, placing patients, their families, and the health care workers who care for these patients at risk.…”