Mortality risks of peritoneal dialysis and hemodialysis

Collins, Allan J.; Hao, Wei; Xia, Hong; Ebben, James; Everson, Susan; Constantini, Edward; Jennie, Z.

doi:10.1016/s0272-6386(99)70012-0

Cited by 326 publications

(259 citation statements)

References 17 publications

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“…Third, by ignoring the number and direction of earlier modality switches, a substantial proportion of individuals labeled as "HD patients" at 3 mo would be misclassified with regard to their original treatment choice. It is in this way that the present study differs from previous studies that used interval analyses but assessed treatment on day 90 (20).…”

Section: Discussionmentioning

confidence: 86%

“…(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.…”

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confidence: 99%

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 86%

mentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…Although this has not previously been described with respect to peritonitis risk, several large US studies demonstrated a higher incidence of death on PD among women, in particular among female patients with diabetes (17)(18)(19). In one study that used USRDS data, Bloembergen et al (17) noted a differential effect of gender on PD outcomes, with women at significantly higher risk for death as a result of infection than men.…”

Section: Discussionmentioning

confidence: 92%

“…In a subsequent comparison of PD and HD outcomes by Vonesh et al (18), female patients with diabetes were one of the few subgroups in which PD was associated with a higher risk for death than HD. Furthermore, Collins et al (19) reported a higher risk for all-cause death for female patients who had diabetes and were Ն55 yr of age and on PD as compared with HD. In cause-specific analyses in the latter study, it was found that these patients had a significantly higher risk for infectious death on PD.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Peritonitis in Patients on Peritoneal Dialysis

Nessim

Bargman

Austin

et al. 2009

Clinical Journal of the American Society of Nephrology

125

103

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Background and objectives: Despite the decreasing incidence of peritonitis among peritoneal dialysis (PD) patients over time, its occurrence is still associated with significant morbidity and mortality. Determining factors that are associated with PD peritonitis may facilitate the identification of patients who are at risk.Design, setting, participants, & measurements: Using data collected in the multicenter Baxter POET database between 1996 and 2005, the study population included incident Canadian PD patients. Potential predictors of peritonitis were sought using a negative binomial model and an Andersen-Gill model. Study variables included age, gender, race, cause of renal disease, diabetes status, transfer from hemodialysis (HD), previous renal transplant, and continuous ambulatory PD (CAPD) versus automated PD (APD).Results: Data were available for 4247 incident PD patients, including 1605 patients with a total of 2555 peritonitis episodes. Using the negative binomial regression model, factors that were independently associated with a higher peritonitis rate included age, Black race, and having transferred from HD. There was an interaction between gender and diabetes, with an increased risk for peritonitis among female patients with diabetes. The use of CAPD versus APD did not affect the peritonitis rate. The Andersen-Gill model for recurrent events yielded similar results.Conclusions: Predictors of PD peritonitis included Black race, transferring from HD to PD, and diabetes among women. In contrast to previous findings, CAPD and APD were similar with regard to peritonitis risk.

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