Similar Outcomes With Hemodialysis and Peritoneal Dialysis in Patients With End-Stage Renal Disease

Mehrotra, Rajnish; Chiu, Ya Wen; Kalantar-Zadeh, Kamyar; Bargman, Joanne M.; Vonesh, Edward F.

doi:10.1001/archinternmed.2010.352

Cited by 423 publications

(372 citation statements)

References 30 publications

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“…Differences in outcome between these two patient groups have been suggested, although the determinants of dialysis modality are largely nonmedical. Two large studies among HD and PD patients showed little difference in risk for death during 2-5 years of follow-up (42,43). Second, we used BMI as a proxy for obesity, but BMI only indirectly reflects the risk stemming from the metabolic effects of an increased fat mass (44).…”

Section: Discussionmentioning

confidence: 99%

Obesity and Mortality Risk among Younger Dialysis Patients

Hoogeveen

Halbesma²,

Rothman

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Many studies show that obesity in dialysis patients is not strongly associated with mortality but not whether this modest association is constant over age. This study investigated the extent to which the relation of body mass index (BMI) and mortality differs between younger and older dialysis patients.Design, setting, participants, & measurements Adult dialysis patients were prospectively followed from their first dialysis treatment for 7 years or until death or transplantation. Patients were stratified by age (,65 or $65 years) and baseline BMI (,20, 20-24 [reference], 25-29, and $30 kg/m 2 ).Results The study sample included 984 patients younger than 65 years and 765 patients 65 years or older; cumulative survival proportions at end of follow-up were 50% and 16%. Age-standardized mortality rate was 1.7 times higher in obese younger patients than those with normal BMI, corresponding to an excess rate of 5.2 deaths/100 patient-years. Mortality rates were almost equal between obese older patients and those with normal BMI. Excess rates of younger and older patients with low compared with normal BMI were 8.7 and 1.1 deaths/100 patient-years. After adjustment for age, sex, smoking, comorbidity, and treatment modality, hazard ratios by increasing BMI were 2.00, 1, 0.95, and 1.57 for younger patients and 1.07, 1, 0.88, and 0.91 for older patients, implying that obesity is a 1.7-fold (95% confidence interval, 1.1-to 2.9-fold) stronger risk factor in younger than older patients.Conclusions In contrast to older dialysis patients, younger patients with low or very high BMI had a substantially elevated risk for death.

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Section: Discussionmentioning

confidence: 99%

Obesity and Mortality Risk among Younger Dialysis Patients

Hoogeveen

Halbesma²,

Rothman

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Mehrotra et al found that outcomes in PD patients improved and there was no significant difference in outcomes between PD and HD patients (17). Improved treatment in PD patients may have resulted in the decreasing SDH Figure 3.…”

Section: Discussionmentioning

confidence: 97%

Comparison of Subdural Hematoma Risk between Hemodialysis and Peritoneal Dialysis Patients with ESRD

Wang

Cheng

Lin

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives This study compared the risk of subdural hematoma (SDH) and subsequent mortality in hemodialysis (HD) and peritoneal dialysis (PD) patients with ESRD.Design, setting, participants, & measurements Claims data were obtained from the National Health Insurance Administration Research Database in Taiwan. This retrospective cohort study comprised 10,136 PD patients and 10,136 HD patients with newly diagnosed ESRD from 1998 to 2010. Patients were matched by propensity score and year of dialysis initiation. Incidence rates and hazard ratios of SDH as well as odds ratios of subsequent 30-day deaths from SDH were evaluated from the date of the first dialysis session to the date when SDH was diagnosed, or the date of renal transplantation, death, withdraw from insurance, or the end of the follow-up period (December 31, 2011).Results Median (25th percentile, 75th percentile) follow-up times for SDH events were 3.61 years (1.91, 6.33) and 3.33 years (1.83, 5.66) in the HD and PD cohorts, respectively. The overall SDH incidence rate (95% confidence interval [95% CI]) was 61.4% higher in the HD cohort than in the PD cohort (34. Conclusions HD patients have a higher risk of developing SDH than PD patients. Both patient groups have a high risk of mortality. Routine education on fall prevention is needed for dialysis patients.

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“…If HD offered improved survival compared with PD, its overwhelming use could be justified. However, no such benefit has been consistently identified (47)(48)(49). In addition, studies demonstrate either no difference in quality of life between HD and PD or greater patient satisfaction with the latter modality (50)(51)(52).…”

Section: Mandating the Modality Of Dialysismentioning

confidence: 99%

The Coming Fiscal Crisis

Andersen

Friedman

2013

Clinical Journal of the American Society of Nephrology

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SummaryNephrologists in the United States face a very uncertain economic future. The astronomical federal debt and unfunded liability burden of Medicare combined with the aging population will place unprecedented strain on the health care sector. To address these fundamental problems, it is conceivable that the federal government will ultimately institute rationing and other budget-cutting measures to rein in costs of ESRD care, which is generously funded relative to other chronic illnesses. Therefore, nephrologists should expect implementation of cost-cutting measures, such age-based rationing, mandated delayed dialysis and home therapies, compensated organ donation, and a shift in research priorities from the dialysis to the predialysis patient population. Nephrologists also need to recognize that these changes, which are geared toward the population level, may make it more difficult to advocate effectively for the needs of individual patients.

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Similar Outcomes With Hemodialysis and Peritoneal Dialysis in Patients With End-Stage Renal Disease

Abstract: In the most recent cohorts, patients who began treatment with HD or PD have similar outcomes.

Cited by 423 publications

References 30 publications

Obesity and Mortality Risk among Younger Dialysis Patients

Obesity and Mortality Risk among Younger Dialysis Patients

Comparison of Subdural Hematoma Risk between Hemodialysis and Peritoneal Dialysis Patients with ESRD

The Coming Fiscal Crisis

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