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

Abstract

Background Up to date, whether hemodialysis (HD) or peritoneal dialysis (PD) is a better choice for end-stage renal disease (ESRD) patients has been debatable. Few study comparing HD and PD was from China, a large country with the largest number of dialysis patients in the world. Method A retrospective cohort study was conducted on ESRD patients who began renal replace treatment from January 1st, 2012 and December 31st, 2017 in Guangdong Provincial Hospital of Chinese Medicine. We used propensity scoring match model to balance the baseline conditions and Cox's multivariate regression analysis to compare mortality between HD and PD patients, and evaluated the relationship between mortality and various baseline covariates. Results 436 HD patients and 501 PD patients were included and we found that PD patients had better survival than HD patients (The 1-, 3- and 5-year survival rates were 98.1% vs 96.4%, 86.7% vs 83.0%, and 73.4% vs 71.9%), even though 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 lower risk of death in the patients who were older than 70 years of age. This difference was still significant after adjustment for a variety of confounding factors. Female, cardiovascular disease, cholesterol, and HD are risk factors of all-cause mortality in the younger subgroup while PD is risk factor in the older subgroup. Conclusion Younger ESRD patients may be more suitable for PD, and the elderly for HD.