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Dialysis Modality and Mortality in the Elderly: A Meta-Analysis.
Clin J Am Soc Nephrol. 2015 Jun 05; 10(6):983-93.CJ

Abstract

BACKGROUND AND OBJECTIVES

Identifying the appropriate choice between hemodialysis (HD) and peritoneal dialysis (PD) is an unresolved issue in elderly patients with ESRD, who are at high risk for death but have a low chance of receiving kidney transplantation.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Data on 13,065 incident dialysis Korean patients (age≥65 years) receiving HD (n=10,675) or PD (n=2390) were obtained from the Korean Health Insurance dataset. Multiple statistical approaches, including the multivariate Cox model, were used to compare mortality between Korean patients receiving PD and those receiving HD. Subsequently, meta-analysis of previous comparison studies (published since the year 2000; population-based studies) and the Korean dataset was performed.

RESULTS

During a mean duration of 1.8±1.3 years (maximum of 5 years), the Korean PD group had a higher mortality rate than the Korean HD group (hazard ratio [HR], 1.20 [95% confidence interval (95% CI), 1.13 to 1.28]; P<0.001 by multivariate Cox model). The discrepancy between the two modalities was greater in the presence of certain conditions, such as diabetes mellitus or longer dialysis duration. In the meta-analysis, 15 studies involving >631,421 elderly patients were reviewed. Compared with HD, the pooled HR with PD was 1.10 (95% CI, 1.01 to 1.20). When the meta-analysis was stratified by confounding factors, the survival benefit from HD was particularly strong in subgroups that had diabetes mellitus, had long dialysis duration (>1 year), or contained cohorts starting dialysis in the 1990s.

CONCLUSIONS

A meta-analysis that included results in Korean patients suggests a higher risk for death in elderly patients receiving PD than in those receiving HD.

Authors+Show Affiliations

Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea;Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea;Medical Research Collaborating Center and.Department of Public Health, Graduate School, Korea University, Seoul, Korea;Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea;Department of Internal Medicine, Wonkwang University College of Medicine, Sanbon Hospital, Gyeonggi-do, Korea; and.Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea;Kidney Research Institute, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea;Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea; dkkim73@gmail.com.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

25941194

Citation

Han, Seung Seok, et al. "Dialysis Modality and Mortality in the Elderly: a Meta-Analysis." Clinical Journal of the American Society of Nephrology : CJASN, vol. 10, no. 6, 2015, pp. 983-93.
Han SS, Park JY, Kang S, et al. Dialysis Modality and Mortality in the Elderly: A Meta-Analysis. Clin J Am Soc Nephrol. 2015;10(6):983-93.
Han, S. S., Park, J. Y., Kang, S., Kim, K. H., Ryu, D. R., Kim, H., Joo, K. W., Lim, C. S., Kim, Y. S., & Kim, D. K. (2015). Dialysis Modality and Mortality in the Elderly: A Meta-Analysis. Clinical Journal of the American Society of Nephrology : CJASN, 10(6), 983-93. https://doi.org/10.2215/CJN.05160514
Han SS, et al. Dialysis Modality and Mortality in the Elderly: a Meta-Analysis. Clin J Am Soc Nephrol. 2015 Jun 5;10(6):983-93. PubMed PMID: 25941194.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dialysis Modality and Mortality in the Elderly: A Meta-Analysis. AU - Han,Seung Seok, AU - Park,Jae Yoon, AU - Kang,Soohee, AU - Kim,Kyoung Hoon, AU - Ryu,Dong-Ryeol, AU - Kim,Hyunwook, AU - Joo,Kwon Wook, AU - Lim,Chun Soo, AU - Kim,Yon Su, AU - Kim,Dong Ki, Y1 - 2015/05/04/ PY - 2014/05/24/received PY - 2015/02/20/accepted PY - 2015/5/6/entrez PY - 2015/5/6/pubmed PY - 2016/3/10/medline KW - dialysis modality KW - elderly KW - hemodialysis KW - mortality KW - peritoneal dialysis SP - 983 EP - 93 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 10 IS - 6 N2 - BACKGROUND AND OBJECTIVES: Identifying the appropriate choice between hemodialysis (HD) and peritoneal dialysis (PD) is an unresolved issue in elderly patients with ESRD, who are at high risk for death but have a low chance of receiving kidney transplantation. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data on 13,065 incident dialysis Korean patients (age≥65 years) receiving HD (n=10,675) or PD (n=2390) were obtained from the Korean Health Insurance dataset. Multiple statistical approaches, including the multivariate Cox model, were used to compare mortality between Korean patients receiving PD and those receiving HD. Subsequently, meta-analysis of previous comparison studies (published since the year 2000; population-based studies) and the Korean dataset was performed. RESULTS: During a mean duration of 1.8±1.3 years (maximum of 5 years), the Korean PD group had a higher mortality rate than the Korean HD group (hazard ratio [HR], 1.20 [95% confidence interval (95% CI), 1.13 to 1.28]; P<0.001 by multivariate Cox model). The discrepancy between the two modalities was greater in the presence of certain conditions, such as diabetes mellitus or longer dialysis duration. In the meta-analysis, 15 studies involving >631,421 elderly patients were reviewed. Compared with HD, the pooled HR with PD was 1.10 (95% CI, 1.01 to 1.20). When the meta-analysis was stratified by confounding factors, the survival benefit from HD was particularly strong in subgroups that had diabetes mellitus, had long dialysis duration (>1 year), or contained cohorts starting dialysis in the 1990s. CONCLUSIONS: A meta-analysis that included results in Korean patients suggests a higher risk for death in elderly patients receiving PD than in those receiving HD. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/25941194/Dialysis_Modality_and_Mortality_in_the_Elderly:_A_Meta_Analysis_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&amp;pmid=25941194 DB - PRIME DP - Unbound Medicine ER -