Hemodialysis versus peritoneal dialysis: A comparison of adjusted mortality rates

Fenton, Stanley; Schaubel, Douglas E.; DesMeules, Marie; Morrison, Howard; Mao, Yang; Copleston, Pauline; Jeffery, John; Kjellstrand, Carl M.

doi:10.1016/s0272-6386(97)90276-6

Cited by 568 publications

(406 citation statements)

References 16 publications

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“…Although the results of these studies were variable, the emerging consensus seemed to be that the outcomes with both of the modalities were similar; however, a study from the US Renal Data System raised questions about this assumption: In that analysis of comparative outcomes of prevalent MHD and PD patients with 170,700 patient-years of follow-up, the death rate for PD patients was 19% higher than that for MHD patients (27). Studies that were conducted in the past decade clearly demonstrated that there is a significant interaction between dialysis vintage and modality (28,29). In other words, the risk for death for PD patients, relative to that for MHD patients, changes over time.…”

Section: Comparative Survival Data Between Mhd and Pdmentioning

confidence: 99%

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Khawar

Kalantar-Zadeh

et al. 2007

Clinical Journal of the American Society of Nephrology

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In the past decade, peritoneal dialysis use among patients with end-stage renal disease has declined in many countries. Studies from the United States indicate that many academic centers do not have adequate resources to train fellows, most incident dialysis patients are not offered peritoneal dialysis, and more than half of dialysis clinics do not have the infrastructure to support peritoneal dialysis. Some are concerned that the outcomes of peritoneal dialysis and maintenance hemodialysis patients may not be equivalent, a notion that is not supported by outcome studies. Given the effect of modality selection on patients' lifestyle, attempts to conduct a randomized, controlled comparison of maintenance hemodialysis and peritoneal dialysis have been unsuccessful. Most observational studies showed that peritoneal dialysis is associated with a survival advantage that diminishes over time; it is unclear whether any of the differences over time are attributable to the modality. Between 1996 and 2003, the early outcomes of peritoneal dialysis patients further improved, whereas those for maintenance hemodialysis patients remained unchanged. Differences in outcomes may be due to residual statistical confounding; however, several biologic mechanisms can be postulated: The early survival advantage may be related to the better preservation of residual renal function with peritoneal dialysis, and the diminution of the survival advantage may be related to worsened volume control. There is a need for large observational and interventional studies among peritoneal dialysis patients to sustain and enforce the improvements in both dialysis therapies.

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Section: Comparative Survival Data Between Mhd and Pdmentioning

confidence: 99%

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Khawar

Kalantar-Zadeh

et al. 2007

Clinical Journal of the American Society of Nephrology

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“…(1-22) These studies vary enormously with regard to population selection criteria, sample size, statistical methodology, definition of treatment, and availability of information on important potential confounders. The various results are conflicting: some studies have found a survival benefit for PD patients (12,16,18,20), others for those on HD (10,11,13), and still others have found mortality not to differ (2)(3)(4)(5)(6)(7)(8)14,15,19,21,22).Many of these previous studies, and all studies on US populations after 1983 have not adequately addressed a key methodologic issue: assessments that start at 4 or 6 mo after onset of RRT are likely to discard relevant events that occur between the first dialysis treatment and the chosen starting point of such studies, particularly modality switches and deaths. This omission can result in biased estimates of effect.…”

mentioning

confidence: 99%

mentioning

confidence: 99%

Comparing Mortality of Elderly Patients on Hemodialysis versus Peritoneal Dialysis

Winkelmayer¹,

Glynn²,

Mittleman³

et al. 2002

Journal of the American Society of Nephrology

142

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Abstract. The objective of this study was to evaluate differences in mortality over the first year of renal replacement therapy (RRT) between elderly patients starting treatment on hemodialysis (HD) versus peritoneal dialysis (PD). For the period of 1991 to mid-1996, this study defined an inception cohort of all patients aged Ͼ65 yr with new-onset chronic RRT who were New Jersey Medicare and/or Medicaid beneficiaries in the year before RRT and who had been diagnosed with renal disease more than 1 yr before RRT. Propensity scores were calculated for first treatment assignment from a large number of baseline covariates. Mortality was then compared among patients initially assigned to HD versus PD using multivariate 90-d interval Cox models controlled for propensity scores and center stratification. Peritoneal dialysis starters had a 16% higher rate of death during the first 90 d of RRT compared with HD patients (hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.96 to 1.42)]. Mortality did not differ between day 91 and 180 (HR, 1.03; 95% CI, 0.71 to 1.51). Thereafter, PD starters again died at a higher rate (HR, 1.45; 95% CI, 1.07 to 1.98). These findings were more pronounced among patients with diabetes. Sensitivity analyses using more stringent criteria to ensure that first treatment choice reflected long-term treatment choice confirmed the presence of an association between PD and mortality. In conclusion, compared with HD, peritoneal dialysis appears to be associated with higher mortality among older patients, particularly among those with diabetes, even after controlling for a large number of risk factors for mortality, propensity scores to control for nonrandom treatment assignment, and center stratification.Various studies have sought to answer the question of whether or not survival on peritoneal dialysis (PD) and hemodialysis (HD) differed. (1-22) These studies vary enormously with regard to population selection criteria, sample size, statistical methodology, definition of treatment, and availability of information on important potential confounders. The various results are conflicting: some studies have found a survival benefit for PD patients (12,16,18,20), others for those on HD (10,11,13), and still others have found mortality not to differ (2)(3)(4)(5)(6)(7)(8)14,15,19,21,22).Many of these previous studies, and all studies on US populations after 1983 have not adequately addressed a key methodologic issue: assessments that start at 4 or 6 mo after onset of RRT are likely to discard relevant events that occur between the first dialysis treatment and the chosen starting point of such studies, particularly modality switches and deaths. This omission can result in biased estimates of effect. Another important potential source of bias that frequently remained unaccounted for is uncontrolled center effects (23). Furthermore, potentially useful techniques developed to enhance control for nonrandom treatment assignment, such as propensity scores (PS) or g-estimation (24,25), have not been used in compa...

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“…Early HD has failed to improve survival, 26,27 and many patients may die before reaching the point of inevitable HD. 28 Peritoneal dialysis is a viable option for many 29 that is underutilized in the US. 30 It awards patients more control and possibly better quality of life.…”

Section: Respect For Autonomy: Patients Are Often Provided Neither Inmentioning

confidence: 99%

Dialysis in the Frail Elderly — A Current Ethical Problem, an Impending Ethical Crisis

2013

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Hemodialysis versus peritoneal dialysis: A comparison of adjusted mortality rates

Cited by 568 publications

References 16 publications

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Comparing Mortality of Elderly Patients on Hemodialysis versus Peritoneal Dialysis

Dialysis in the Frail Elderly — A Current Ethical Problem, an Impending Ethical Crisis

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