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Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease.

Abstract

BACKGROUND

The influence of type of dialysis on survival of patients with end-stage renal disease (ESRD) is controversial.

OBJECTIVE

To compare risk for death among patients with ESRD who receive peritoneal dialysis or hemodialysis.

DESIGN

Prospective cohort study.

SETTING

81 dialysis clinics in 19 U.S. states.

PATIENTS

1041 patients starting dialysis (274 patients receiving peritoneal dialysis and 767 patients receiving hemodialysis) at baseline.

MEASUREMENTS

Patients were followed for up to 7 years and censored at transplantation or loss to follow-up. Cox proportional hazards regression stratified by clinic was used to compare the risk for death with peritoneal dialysis versus hemodialysis.

RESULTS

Twenty-five percent of patients undergoing peritoneal dialysis and 5% of hemodialysis patients switched type of dialysis. After adjustment, the risk for death did not differ between patients undergoing peritoneal dialysis and those undergoing hemodialysis during the first year (relative hazard, 1.39 [95% CI, 0.64 to 3.06]), but the risk became significantly higher among those undergoing peritoneal dialysis in the second year (relative hazard, 2.34 [CI, 1.19 to 4.59]). After stratification, the survival rate was no different for patients who had the highest propensity of being initially treated with peritoneal dialysis. Results were consistent with adjustment based on a propensity score model and in sensitivity analyses that used as-treated models and models in which switches in type of dialysis were treated as treatment failures. Results were similar but stronger in analyses that were restricted to patients who were treated only in clinics offering both types of dialysis.

LIMITATIONS

Patients were not randomly assigned to their initial type of dialysis. Also, more patients undergoing peritoneal dialysis than hemodialysis switched type of dialysis over time, and the reason for switching was often a consequence of the technique.

CONCLUSIONS

The risk for death in patients with ESRD undergoing dialysis depends on dialysis type. Further studies are needed to evaluate a possible survival benefit of a timely change from peritoneal dialysis to hemodialysis.

Links

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  • Authors+Show Affiliations

    ,

    Johns Hopkins University School of Medicine, Johns Hopkins Bloomberg School of Public Health, and Independent Dialysis Foundation, Baltimore, Maryland 21205, USA. bjaar@jhmi.edu

    , , , , , , , ,

    Source

    Annals of internal medicine 143:3 2005 Aug 02 pg 174-83

    MeSH

    Cardiovascular Diseases
    Female
    Follow-Up Studies
    Humans
    Kidney Failure, Chronic
    Male
    Middle Aged
    Peritoneal Dialysis
    Proportional Hazards Models
    Prospective Studies
    Renal Dialysis
    Risk Factors
    Sensitivity and Specificity
    Survival Analysis
    United States

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    16061915

    Citation

    Jaar, Bernard G., et al. "Comparing the Risk for Death With Peritoneal Dialysis and Hemodialysis in a National Cohort of Patients With Chronic Kidney Disease." Annals of Internal Medicine, vol. 143, no. 3, 2005, pp. 174-83.
    Jaar BG, Coresh J, Plantinga LC, et al. Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease. Ann Intern Med. 2005;143(3):174-83.
    Jaar, B. G., Coresh, J., Plantinga, L. C., Fink, N. E., Klag, M. J., Levey, A. S., ... Powe, N. R. (2005). Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease. Annals of Internal Medicine, 143(3), pp. 174-83.
    Jaar BG, et al. Comparing the Risk for Death With Peritoneal Dialysis and Hemodialysis in a National Cohort of Patients With Chronic Kidney Disease. Ann Intern Med. 2005 Aug 2;143(3):174-83. PubMed PMID: 16061915.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease. AU - Jaar,Bernard G, AU - Coresh,Josef, AU - Plantinga,Laura C, AU - Fink,Nancy E, AU - Klag,Michael J, AU - Levey,Andrew S, AU - Levin,Nathan W, AU - Sadler,John H, AU - Kliger,Alan, AU - Powe,Neil R, PY - 2005/8/3/pubmed PY - 2005/8/9/medline PY - 2005/8/3/entrez SP - 174 EP - 83 JF - Annals of internal medicine JO - Ann. Intern. Med. VL - 143 IS - 3 N2 - BACKGROUND: The influence of type of dialysis on survival of patients with end-stage renal disease (ESRD) is controversial. OBJECTIVE: To compare risk for death among patients with ESRD who receive peritoneal dialysis or hemodialysis. DESIGN: Prospective cohort study. SETTING: 81 dialysis clinics in 19 U.S. states. PATIENTS: 1041 patients starting dialysis (274 patients receiving peritoneal dialysis and 767 patients receiving hemodialysis) at baseline. MEASUREMENTS: Patients were followed for up to 7 years and censored at transplantation or loss to follow-up. Cox proportional hazards regression stratified by clinic was used to compare the risk for death with peritoneal dialysis versus hemodialysis. RESULTS: Twenty-five percent of patients undergoing peritoneal dialysis and 5% of hemodialysis patients switched type of dialysis. After adjustment, the risk for death did not differ between patients undergoing peritoneal dialysis and those undergoing hemodialysis during the first year (relative hazard, 1.39 [95% CI, 0.64 to 3.06]), but the risk became significantly higher among those undergoing peritoneal dialysis in the second year (relative hazard, 2.34 [CI, 1.19 to 4.59]). After stratification, the survival rate was no different for patients who had the highest propensity of being initially treated with peritoneal dialysis. Results were consistent with adjustment based on a propensity score model and in sensitivity analyses that used as-treated models and models in which switches in type of dialysis were treated as treatment failures. Results were similar but stronger in analyses that were restricted to patients who were treated only in clinics offering both types of dialysis. LIMITATIONS: Patients were not randomly assigned to their initial type of dialysis. Also, more patients undergoing peritoneal dialysis than hemodialysis switched type of dialysis over time, and the reason for switching was often a consequence of the technique. CONCLUSIONS: The risk for death in patients with ESRD undergoing dialysis depends on dialysis type. Further studies are needed to evaluate a possible survival benefit of a timely change from peritoneal dialysis to hemodialysis. SN - 1539-3704 UR - https://www.unboundmedicine.com/medline/citation/16061915/Comparing_the_risk_for_death_with_peritoneal_dialysis_and_hemodialysis_in_a_national_cohort_of_patients_with_chronic_kidney_disease_ L2 - https://www.annals.org/article.aspx?volume=143&issue=3&page=174 DB - PRIME DP - Unbound Medicine ER -