Effects of dialysis modality choice on the survival of end-stage renal disease patients in southern China: a retrospective cohort study

Abstract

Background: The optimal choice of treatment, with hemodialysis (HD) or peritoneal dialysis (PD), for end-stage renal disease (ESRD) patients, is yet controversial. Only a few studies comparing HD and PD have been conducted in China with the largest number of dialysis patients in the world.Methods: A retrospective cohort study was conducted on ESRD patients who began renal replacement treatment from January 1, 2012 to December 31, 2017 in Guangdong Provincial Hospital of Chinese Medicine. Propensity scoring match was applied to balance the baseline conditions and multivariate Cox regression analysis to compare the mortality between HD and PD patients, and evaluated the correlation between mortality and various baseline characteristics.Results: A total of 436 HD patients and 501 PD patients were included in this study, and PD patients had better survival than HD patients, but the difference was not statistically significant. For younger ESRD patients (≤60-years-old), the overall survival of PD was better than that of HD, but HD was associated with a lower risk of death in older patients (>70-years-old). This difference was still significant after adjustment for a variety of confounding factors. Female gender, age of dialysis initiation, cardiovascular disease, cholesterol, and HD were risk factors of all-cause mortality in the younger subgroup, while PD was risk factors in the older subgroup.Conclusion: Younger ESRD patients may be suitable for PD, and the older ESRD patients for HD.