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Comparing mortality of elderly patients on hemodialysis versus peritoneal dialysis: a propensity score approach.

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 >65 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.

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  • Authors+Show Affiliations

    ,

    Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA. wolfgang@post.harvard.edu

    , , , ,

    Source

    MeSH

    Aged
    Aged, 80 and over
    Bias
    Cohort Studies
    Female
    Humans
    Kidney Failure, Chronic
    Male
    New Jersey
    Peritoneal Dialysis
    Proportional Hazards Models
    Renal Dialysis
    Risk Factors
    Sensitivity and Specificity
    Survival Analysis

    Pub Type(s)

    Comparative Study
    Journal Article
    Multicenter Study
    Research Support, U.S. Gov't, Non-P.H.S.
    Research Support, U.S. Gov't, P.H.S.

    Language

    eng

    PubMed ID

    12191980

    Citation

    Winkelmayer, Wolfgang C., et al. "Comparing Mortality of Elderly Patients On Hemodialysis Versus Peritoneal Dialysis: a Propensity Score Approach." Journal of the American Society of Nephrology : JASN, vol. 13, no. 9, 2002, pp. 2353-62.
    Winkelmayer WC, Glynn RJ, Mittleman MA, et al. Comparing mortality of elderly patients on hemodialysis versus peritoneal dialysis: a propensity score approach. J Am Soc Nephrol. 2002;13(9):2353-62.
    Winkelmayer, W. C., Glynn, R. J., Mittleman, M. A., Levin, R., Pliskin, J. S., & Avorn, J. (2002). Comparing mortality of elderly patients on hemodialysis versus peritoneal dialysis: a propensity score approach. Journal of the American Society of Nephrology : JASN, 13(9), pp. 2353-62.
    Winkelmayer WC, et al. Comparing Mortality of Elderly Patients On Hemodialysis Versus Peritoneal Dialysis: a Propensity Score Approach. J Am Soc Nephrol. 2002;13(9):2353-62. PubMed PMID: 12191980.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Comparing mortality of elderly patients on hemodialysis versus peritoneal dialysis: a propensity score approach. AU - Winkelmayer,Wolfgang C, AU - Glynn,Robert J, AU - Mittleman,Murray A, AU - Levin,Raisa, AU - Pliskin,Joseph S, AU - Avorn,Jerry, PY - 2002/8/23/pubmed PY - 2003/2/13/medline PY - 2002/8/23/entrez SP - 2353 EP - 62 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 13 IS - 9 N2 - 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 >65 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. SN - 1046-6673 UR - https://www.unboundmedicine.com/medline/citation/12191980/Comparing_mortality_of_elderly_patients_on_hemodialysis_versus_peritoneal_dialysis:_a_propensity_score_approach_ L2 - http://jasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=12191980 DB - PRIME DP - Unbound Medicine ER -