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

He, Zhiren; Hou, Huilian; Zhang, Difei; Mo, Yenan; La, Zhang; Su, Guobin; Lin, Junjie; Lu, Liming; Huang, Jinke; Gu, Yewen; Zhang, Ying; Lin, Jingxia; Yuan, Fengling; Yu, Peng; Liang, Hui; Zhao, Daixin; Lu, Fuhua; Liu, Xusheng; Wang, Lixin

doi:10.1186/s12882-020-02070-7

Cited by 18 publications

(17 citation statements)

References 27 publications

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“…Subgroup analyses were performed with respect to age. Previous studies ( 15 ) suggested that patients undergoing HD and PD have different prognoses in different age subgroups. Therefore, we used a Cox regression model to confirm the interactive effect of age and dialysis type.…”

Section: Methodsmentioning

confidence: 99%

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Impact of dialysis modality choice on the survival of end-stage renal disease patients with congestive heart failure in southern China: A retrospective cohort study

Liang²,

Huang³

et al. 2022

Front. Med.

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Background and objectHeart failure is one of the common complications in patients with end-stage renal disease (ESRD) and a major cause of death in these patients. The choice of dialysis modality for ESRD patients with congestive heart failure (CHF) is still inconclusive. The purpose of this study was to compare the prognosis of hemodialysis (HD) and peritoneal dialysis (PD) among ESRD patients with CHF and provide a basis for clinical decision-making.Materials and methodsThis was a retrospective study conducted at Guangdong Provincial Hospital of Traditional Chinese Medicine that included patients with CHF requiring long-term renal replacement therapy between January 1, 2012 and December 31, 2017. The end of follow-up was December 31, 2020. All patients were divided into HD and PD groups and sub grouped by age, and we used univariate and multifactorial Cox regression analyses to calculate the relative hazard ratios (HR) of the different dialysis types and adjusted for differences in baseline data using propensity score matching (PSM).ResultA total of 121 patients with PD and 156 patients with HD were included in this study. Among younger ESRD patients (≤65 years of age) with CHF, the prognosis of HD was worse than that of PD [HR = 1.84, 95% confidence interval (CI) = 1.01–3.34], and this disadvantage remained significant in the fully adjusted model [sex, age at dialysis initiation, Charlson comorbidities index, body mass index, prealbumin, hemoglobin, and left ventricular ejection fraction (LVEF)] and after PSM. In the older group (>65 years of age), the prognosis of HD was better than that of PD (HR = 0.46, 95% CI = 0.25–0.85), and the protective effect remained in the fully adjusted model and after PSM. The aforementioned survival differences across the cohort were maintained in patients with preserved LVEF (>55%), but could not be reproduced in patients with reduced LVEF (≤55%).ConclusionIn southern China, PD is a better choice for younger patients with ESRD, CHF and preserved LVEF, and HD is the better option for older patients.

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Section: Methodsmentioning

confidence: 99%

“…Previous studies at our center have shown that the prognoses of PD and HD are different for end-stage renal patients at different ages ( 15 ). We hypothesize that the prognosis of ESRD patients with CHF receiving different dialysis methods may be different.…”

Section: Introductionmentioning

confidence: 96%

Impact of dialysis modality choice on the survival of end-stage renal disease patients with congestive heart failure in southern China: A retrospective cohort study

Liang²,

Huang³

et al. 2022

Front. Med.

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“…A 10‐year cohort study of elderly ESRD patients, in Taiwan, showed a mortality of 354.30/1000 person‐years in hemodialysis patients and 152.04/1000 person‐years in non‐hemodialysis patients 11 . A previous study in Guangdong, China, reported that the 5‐year survival rate of ESRD patients was over 70%, and the survival of elderly patients was significantly lower than that of younger patients 12 . With the development of diagnosis and treatment technology, the survival probability of patients has improved, and the survival time has been continuously extended, but there is still a lack of survival estimation of ESRD patients treated for more than 10 years in China.…”

Section: Introductionmentioning

confidence: 99%

“…In dialysis treatment, the elderly and younger ESRD patients need to face different dilemmas. Older patients may suffer from poor physical health due to more comorbidities, which affects their treatment regimen and medical expenses and increases the risk of mortality, while young and middle‐aged patients may have poor survival status owing to their more social participation and economic burden 12,23 . Therefore, patients with ESRD were divided into three groups (young, middle‐aged, and elderly) in this study, for stratified comparison.…”

Section: Introductionmentioning

confidence: 99%

Effects of dialysis modality on mortality in patients with end‐stage renal disease: A cohort study

Sun

Lü

et al. 2022

Seminars in Dialysis

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Methods Using a retrospective 15‐year cohort, stratified by age, this study aimed to analyze the effect of dialysis modality on mortality of ESRD patients in a city of China. Study data were from the medical insurance information system of Kunshan, Jiangsu Province of China, and 1484 patients with ESRD, enrolled from 1 January 2005 to 31 December 2019 were included in this study. The primary outcome event was all‐cause mortality, which was calculated in months. Dialysis modalities included hemodialysis (HD) and peritoneal dialysis (PD). Survival analysis and competing‐risk regression model were performed in this study. Results HD costs significantly higher medical expense than the PD treatment regimen. The mean survival time was 121.28 (SE = 3.020) months for HD patients, while that was 94.68 (SE = 3.534) months for the PD. Ten‐year survival rates of the young, middle‐aged, and elderly were 0.82, 0.56, and 0.26, respectively. For the young (SHR = 0.869, 95% CI: 0.525–1.436) and middle‐aged (SHR = 0.715, 95% CI: 0.484–1.057) ESRD patients, different dialysis modalities exhibited no statistical significance on the survival, but for the elderly, HD had a lower risk of mortality than PD (SHR = 0.747, 95% CI: 0.581–0.961). Conclusion Survival of the young and middle‐aged ESRD patients was superior to that of the elderly. Considering both survival time and direct medical costs, we recommend that PD could be a better choice for young and middle‐aged ESRD patients, while HD may be suitable for older patients.

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“…In addition, the quality of life for a CKD patient is better when undergoing PD than HD [6]. A retrospective cohort study showed that PD is considered a better choice of KRT in young patients [7]. A survey of Saudi ESKD patients undergoing HD suggested that their refusal of PD is related to a lack of prior and adequate counseling and education about PD [8].…”

Section: Introductionmentioning

confidence: 99%

Chronic Kidney Disease Education Class Improves Rates of Early Access Creation and Peritoneal Dialysis Enrollment

Aloudah¹,

Alanazi²,

Alrehaily³

et al. 2022

Cureus

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BackgroundMost patients with end-stage kidney disease begin hemodialysis (HD) in an unplanned fashion at a late stage, necessitating the commencement of HD with a temporary venous catheter, the least favorable option. Alternative modalities of kidney replacement therapy (KRT), peritoneal dialysis (PD), and preemptive transplant offer similar or better outcomes than HD at a lower overall cost, and yet they remain underutilized in Saudi Arabia. Early education may help prepare patients with advanced chronic kidney disease (CKD IV and V) to accept their disease and choose a KRT modality that minimizes complications and matches their lifestyle.The aim of the study is to assess the impact of a pilot educational class on therapy choices and outcomes. MethodologyIn a cross-sectional study, we conducted phone interviews and reviewed medical records of 81 attendees of the multidisciplinary monthly educational class about KRT that was held at the King Abdulaziz Medical City (KAMC) from January 2017 to October 2021. The interview was conducted at least one year after the participants attended the class. The study proposal, consent, and questionnaire were approved by the King Abdulaziz International Medical Research Center. Patient data was retrieved from KAMC electronic medical record system. ResultsVolunteer participation in the survey was high (62/81). For the respondents, a preemptive kidney transplant was the most preferred (48/62, 77%) option for KRT. Among the preferred fallback options, HD was the most frequently chosen (29/62, 47%) compared to PD (26/62, 41.9%). At the time of the interview, a great majority of the patients (54/62, 87%) was already on KRT, including about half (26/54, 48%) on HD via a catheter, and the rest about equally divided between those on HD via an arteriovenous (AF) fistula (13/54, 24%) and those on PD (15/54, 28%). Thus, half of the respondents on KRT (28/54, 51%) avoided urgent HD catheter commencement. However, because of an unfortunate shortage of donors, only a small minority (2/62, 3%) of patients received preemptive transplantation. ConclusionThe KAMC CKD education class helped boost the fraction of patients, significantly above the national average, who accepted the diagnosis of kidney failure and pursued preemptive native HD access or enrolled in PD.

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

Cited by 18 publications

References 27 publications

Impact of dialysis modality choice on the survival of end-stage renal disease patients with congestive heart failure in southern China: A retrospective cohort study

Impact of dialysis modality choice on the survival of end-stage renal disease patients with congestive heart failure in southern China: A retrospective cohort study

Effects of dialysis modality on mortality in patients with end‐stage renal disease: A cohort study

Chronic Kidney Disease Education Class Improves Rates of Early Access Creation and Peritoneal Dialysis Enrollment

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