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Long-term modality-related mortality analysis in incident dialysis patients.

Abstract

BACKGROUND

The effects of the various dialysis modalities on patient survival are different, especially for diabetic patients. Hemodialysis (HD) and peritoneal dialysis (PD) are the predominant renal replacement modalities. This study analyzes modality-related mortality in long-term dialysis patients.

METHODS

This prospective cohort study was conducted between May 1991 and October 2005. Incident patients that had initiated dialysis and had been on dialysis for more than 3 months were enrolled. All cause, infection related, and cardiovascular disease-related mortalities were used as end points. Patient survival was analyzed by the Cox proportional hazards model after adjusting for age, sex, diabetes, comorbidity, and time-averaged values of laboratory data to control influential covariates.

RESULTS

In total, 1347 patients (258 on PD and 1089 on HD) were enrolled. Adjusted all cause, infection related, and cardiovascular disease-related mortality did not differ significantly between HD and PD patients. In diabetic patients, adjusted all-cause [HD vs PD: hazard ratio (HR) 0.717, 95% confidence interval (CI) 0.400 - 1.282] and infection-related mortality (HD vs PD: HR 1.341, 95% CI 0.453 - 3.969) did not differ significantly between patients on HD and patients on PD. However, adjusted cardiovascular disease-related mortality increased significantly in diabetic PD patients (HD vs PD: HR 0.375, 95% CI 0.154 - 0.913). For nondiabetic patients, adjusted all cause, infection related, and cardiovascular disease-related mortality did not differ significantly between HD and PD patients.

CONCLUSIONS

Dialysis modality had no significant impact on all-cause or infection-related mortality. More studies are needed to clarify the putative difference in cardiovascular mortality risk between diabetic patients on PD and diabetic patients on HD.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    School of Medicine, Chang Gung University, Taoyuan, Taiwan.

    ,

    Source

    MeSH

    Adult
    Aged
    Cohort Studies
    Female
    Humans
    Kidney Failure, Chronic
    Male
    Middle Aged
    Peritoneal Dialysis
    Proportional Hazards Models
    Renal Dialysis
    Retrospective Studies
    Risk Factors
    Survival Analysis
    Survival Rate

    Pub Type(s)

    Comparative Study
    Journal Article

    Language

    eng

    PubMed ID

    19293356

    Citation

    Lee, Chin-Chan, et al. "Long-term Modality-related Mortality Analysis in Incident Dialysis Patients." Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, vol. 29, no. 2, 2009, pp. 182-90.
    Lee CC, Sun CY, Wu MS. Long-term modality-related mortality analysis in incident dialysis patients. Perit Dial Int. 2009;29(2):182-90.
    Lee, C. C., Sun, C. Y., & Wu, M. S. (2009). Long-term modality-related mortality analysis in incident dialysis patients. Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, 29(2), pp. 182-90.
    Lee CC, Sun CY, Wu MS. Long-term Modality-related Mortality Analysis in Incident Dialysis Patients. Perit Dial Int. 2009;29(2):182-90. PubMed PMID: 19293356.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Long-term modality-related mortality analysis in incident dialysis patients. AU - Lee,Chin-Chan, AU - Sun,Chiao-Yin, AU - Wu,Mai-Szu, PY - 2009/3/19/entrez PY - 2009/3/19/pubmed PY - 2009/6/18/medline SP - 182 EP - 90 JF - Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis JO - Perit Dial Int VL - 29 IS - 2 N2 - BACKGROUND: The effects of the various dialysis modalities on patient survival are different, especially for diabetic patients. Hemodialysis (HD) and peritoneal dialysis (PD) are the predominant renal replacement modalities. This study analyzes modality-related mortality in long-term dialysis patients. METHODS: This prospective cohort study was conducted between May 1991 and October 2005. Incident patients that had initiated dialysis and had been on dialysis for more than 3 months were enrolled. All cause, infection related, and cardiovascular disease-related mortalities were used as end points. Patient survival was analyzed by the Cox proportional hazards model after adjusting for age, sex, diabetes, comorbidity, and time-averaged values of laboratory data to control influential covariates. RESULTS: In total, 1347 patients (258 on PD and 1089 on HD) were enrolled. Adjusted all cause, infection related, and cardiovascular disease-related mortality did not differ significantly between HD and PD patients. In diabetic patients, adjusted all-cause [HD vs PD: hazard ratio (HR) 0.717, 95% confidence interval (CI) 0.400 - 1.282] and infection-related mortality (HD vs PD: HR 1.341, 95% CI 0.453 - 3.969) did not differ significantly between patients on HD and patients on PD. However, adjusted cardiovascular disease-related mortality increased significantly in diabetic PD patients (HD vs PD: HR 0.375, 95% CI 0.154 - 0.913). For nondiabetic patients, adjusted all cause, infection related, and cardiovascular disease-related mortality did not differ significantly between HD and PD patients. CONCLUSIONS: Dialysis modality had no significant impact on all-cause or infection-related mortality. More studies are needed to clarify the putative difference in cardiovascular mortality risk between diabetic patients on PD and diabetic patients on HD. SN - 0896-8608 UR - https://www.unboundmedicine.com/medline/citation/19293356/Long_term_modality_related_mortality_analysis_in_incident_dialysis_patients_ L2 - http://www.pdiconnect.com/cgi/pmidlookup?view=long&pmid=19293356 DB - PRIME DP - Unbound Medicine ER -