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Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients.

Abstract

Contemporary comparisons of mortality in matched hemodialysis and peritoneal dialysis patients are lacking. We aimed to compare survival of incident hemodialysis and peritoneal dialysis patients by intention-to-treat analysis in a matched-pair cohort and in subsets defined by age, cardiovascular disease, and diabetes. We matched 6337 patient pairs from a retrospective cohort of 98,875 adults who initiated dialysis in 2003 in the United States. In the primary intention-to-treat analysis of survival from day 0, cumulative survival was higher for peritoneal dialysis patients than for hemodialysis patients (hazard ratio 0.92; 95% CI 0.86 to 1.00, P = 0.04). Cumulative survival probabilities for peritoneal dialysis versus hemodialysis were 85.8% versus 80.7% (P < 0.01), 71.1% versus 68.0% (P < 0.01), 58.1% versus 56.7% (P = 0.25), and 48.4% versus 47.3% (P = 0.50) at 12, 24, 36, and 48 months, respectively. Peritoneal dialysis was associated with improved survival compared with hemodialysis among subgroups with age <65 years, no cardiovascular disease, and no diabetes. In a sensitivity analysis of survival from 90 days after initiation, we did not detect a difference in survival between modalities overall (hazard ratio 1.05; 95% CI 0.96 to 1.16), but hemodialysis was associated with improved survival among subgroups with cardiovascular disease and diabetes. In conclusion, despite hazard ratio heterogeneity across patient subgroups and nonconstant hazard ratios during the follow-up period, the overall intention-to-treat mortality risk after dialysis initiation was 8% lower for peritoneal dialysis than for matched hemodialysis patients. These data suggest that increased use of peritoneal dialysis may benefit incident ESRD patients.

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  • Authors+Show Affiliations

    ,

    Chronic Disease Research Group, Minneapolis, MN 55404, USA.

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    Source

    MeSH

    Adult
    Aged
    Female
    Humans
    Incidence
    Kaplan-Meier Estimate
    Kidney Failure, Chronic
    Logistic Models
    Male
    Matched-Pair Analysis
    Middle Aged
    Peritoneal Dialysis
    Proportional Hazards Models
    Renal Dialysis
    Risk Factors

    Pub Type(s)

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

    Language

    eng

    PubMed ID

    20133483

    Citation

    Weinhandl, Eric D., et al. "Propensity-matched Mortality Comparison of Incident Hemodialysis and Peritoneal Dialysis Patients." Journal of the American Society of Nephrology : JASN, vol. 21, no. 3, 2010, pp. 499-506.
    Weinhandl ED, Foley RN, Gilbertson DT, et al. Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol. 2010;21(3):499-506.
    Weinhandl, E. D., Foley, R. N., Gilbertson, D. T., Arneson, T. J., Snyder, J. J., & Collins, A. J. (2010). Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. Journal of the American Society of Nephrology : JASN, 21(3), pp. 499-506. doi:10.1681/ASN.2009060635.
    Weinhandl ED, et al. Propensity-matched Mortality Comparison of Incident Hemodialysis and Peritoneal Dialysis Patients. J Am Soc Nephrol. 2010;21(3):499-506. PubMed PMID: 20133483.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. AU - Weinhandl,Eric D, AU - Foley,Robert N, AU - Gilbertson,David T, AU - Arneson,Thomas J, AU - Snyder,Jon J, AU - Collins,Allan J, Y1 - 2010/02/04/ PY - 2010/2/6/entrez PY - 2010/2/6/pubmed PY - 2010/3/26/medline SP - 499 EP - 506 JF - Journal of the American Society of Nephrology : JASN JO - J. Am. Soc. Nephrol. VL - 21 IS - 3 N2 - Contemporary comparisons of mortality in matched hemodialysis and peritoneal dialysis patients are lacking. We aimed to compare survival of incident hemodialysis and peritoneal dialysis patients by intention-to-treat analysis in a matched-pair cohort and in subsets defined by age, cardiovascular disease, and diabetes. We matched 6337 patient pairs from a retrospective cohort of 98,875 adults who initiated dialysis in 2003 in the United States. In the primary intention-to-treat analysis of survival from day 0, cumulative survival was higher for peritoneal dialysis patients than for hemodialysis patients (hazard ratio 0.92; 95% CI 0.86 to 1.00, P = 0.04). Cumulative survival probabilities for peritoneal dialysis versus hemodialysis were 85.8% versus 80.7% (P < 0.01), 71.1% versus 68.0% (P < 0.01), 58.1% versus 56.7% (P = 0.25), and 48.4% versus 47.3% (P = 0.50) at 12, 24, 36, and 48 months, respectively. Peritoneal dialysis was associated with improved survival compared with hemodialysis among subgroups with age <65 years, no cardiovascular disease, and no diabetes. In a sensitivity analysis of survival from 90 days after initiation, we did not detect a difference in survival between modalities overall (hazard ratio 1.05; 95% CI 0.96 to 1.16), but hemodialysis was associated with improved survival among subgroups with cardiovascular disease and diabetes. In conclusion, despite hazard ratio heterogeneity across patient subgroups and nonconstant hazard ratios during the follow-up period, the overall intention-to-treat mortality risk after dialysis initiation was 8% lower for peritoneal dialysis than for matched hemodialysis patients. These data suggest that increased use of peritoneal dialysis may benefit incident ESRD patients. SN - 1533-3450 UR - https://www.unboundmedicine.com/medline/citation/20133483/full_citation L2 - http://jasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=20133483 DB - PRIME DP - Unbound Medicine ER -