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Comparing mortality of peritoneal and hemodialysis patients in the first 2 years of dialysis therapy: a marginal structural model analysis.
Clin J Am Soc Nephrol. 2013 Apr; 8(4):619-28.CJ

Abstract

BACKGROUND AND OBJECTIVES

There are conflicting research results about the survival differences between hemodialysis and peritoneal dialysis, especially during the first 2 years of dialysis treatment. Given the challenges of conducting randomized trials, differential rates of modality switch and transplantation, and time-varying confounding in cohort data during the first years of dialysis treatment, use of novel analytical techniques in observational cohorts can help examine the peritoneal dialysis versus hemodialysis survival discrepancy.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

This study examined a cohort of incident dialysis patients who initiated dialysis in DaVita dialysis facilities between July of 2001 and June of 2004 and were followed for 24 months. This study used the causal modeling technique of marginal structural models to examine the survival differences between peritoneal dialysis and hemodialysis over the first 24 months, accounting for modality change, differential transplantation rates, and detailed time-varying laboratory measurements.

RESULTS

On dialysis treatment day 90, there were 23,718 incident dialysis-22,360 hemodialysis and 1,358 peritoneal dialysis-patients. Incident peritoneal dialysis patients were younger, had fewer comorbidities, and were nine and three times more likely to switch dialysis modality and receive kidney transplantation over the 2-year period, respectively, compared with hemodialysis patients. In marginal structural models analyses, peritoneal dialysis was associated with persistently greater survival independent of the known confounders, including dialysis modality switch and transplant censorship (i.e., death hazard ratio of 0.52 [95% confidence limit 0.34-0.80]).

CONCLUSIONS

Peritoneal dialysis seems to be associated with 48% lower mortality than hemodialysis over the first 2 years of dialysis therapy independent of modality switches or differential transplantation rates.

Authors+Show Affiliations

Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, University of California Irvine Medical Center, Orange, CA, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

23307879

Citation

Lukowsky, Lilia R., et al. "Comparing Mortality of Peritoneal and Hemodialysis Patients in the First 2 Years of Dialysis Therapy: a Marginal Structural Model Analysis." Clinical Journal of the American Society of Nephrology : CJASN, vol. 8, no. 4, 2013, pp. 619-28.
Lukowsky LR, Mehrotra R, Kheifets L, et al. Comparing mortality of peritoneal and hemodialysis patients in the first 2 years of dialysis therapy: a marginal structural model analysis. Clin J Am Soc Nephrol. 2013;8(4):619-28.
Lukowsky, L. R., Mehrotra, R., Kheifets, L., Arah, O. A., Nissenson, A. R., & Kalantar-Zadeh, K. (2013). Comparing mortality of peritoneal and hemodialysis patients in the first 2 years of dialysis therapy: a marginal structural model analysis. Clinical Journal of the American Society of Nephrology : CJASN, 8(4), 619-28. https://doi.org/10.2215/CJN.04810512
Lukowsky LR, et al. Comparing Mortality of Peritoneal and Hemodialysis Patients in the First 2 Years of Dialysis Therapy: a Marginal Structural Model Analysis. Clin J Am Soc Nephrol. 2013;8(4):619-28. PubMed PMID: 23307879.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparing mortality of peritoneal and hemodialysis patients in the first 2 years of dialysis therapy: a marginal structural model analysis. AU - Lukowsky,Lilia R, AU - Mehrotra,Rajnish, AU - Kheifets,Leeka, AU - Arah,Onyebuchi A, AU - Nissenson,Allen R, AU - Kalantar-Zadeh,Kamyar, Y1 - 2013/01/10/ PY - 2013/1/12/entrez PY - 2013/1/12/pubmed PY - 2013/10/1/medline SP - 619 EP - 28 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 8 IS - 4 N2 - BACKGROUND AND OBJECTIVES: There are conflicting research results about the survival differences between hemodialysis and peritoneal dialysis, especially during the first 2 years of dialysis treatment. Given the challenges of conducting randomized trials, differential rates of modality switch and transplantation, and time-varying confounding in cohort data during the first years of dialysis treatment, use of novel analytical techniques in observational cohorts can help examine the peritoneal dialysis versus hemodialysis survival discrepancy. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study examined a cohort of incident dialysis patients who initiated dialysis in DaVita dialysis facilities between July of 2001 and June of 2004 and were followed for 24 months. This study used the causal modeling technique of marginal structural models to examine the survival differences between peritoneal dialysis and hemodialysis over the first 24 months, accounting for modality change, differential transplantation rates, and detailed time-varying laboratory measurements. RESULTS: On dialysis treatment day 90, there were 23,718 incident dialysis-22,360 hemodialysis and 1,358 peritoneal dialysis-patients. Incident peritoneal dialysis patients were younger, had fewer comorbidities, and were nine and three times more likely to switch dialysis modality and receive kidney transplantation over the 2-year period, respectively, compared with hemodialysis patients. In marginal structural models analyses, peritoneal dialysis was associated with persistently greater survival independent of the known confounders, including dialysis modality switch and transplant censorship (i.e., death hazard ratio of 0.52 [95% confidence limit 0.34-0.80]). CONCLUSIONS: Peritoneal dialysis seems to be associated with 48% lower mortality than hemodialysis over the first 2 years of dialysis therapy independent of modality switches or differential transplantation rates. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/23307879/Comparing_mortality_of_peritoneal_and_hemodialysis_patients_in_the_first_2_years_of_dialysis_therapy:_a_marginal_structural_model_analysis_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=23307879 DB - PRIME DP - Unbound Medicine ER -