Comparison of Survival Rates Between Incident Hemodialysis Patients and Peritoneal Dialysis Patients: a 5-year Prospective Cohort Study with Propensity Score Matching

Overview

Journal Clin Exp Nephrol

Publisher Springer

Specialty Nephrology

Date 2023 Jan 23

PMID 36689034

Authors

Mami Miyazaki

Kensuke Sasaki

Ayumu Nakashima

Akira Takahashi

Naoki Ishiuchi

Ryo Tamura

Yosuke Osaki

Shigehiro Doi

Takao Masaki

Affiliations

Soon will be listed here.

Abstract

Background: The effect of dialytic modality at the start of renal replacement therapy on prognosis is controversial.

Methods: This multicenter, prospective cohort study included patients undergoing incident hemodialysis (HD) (n = 646) and peritoneal dialysis (PD) (n = 72). We excluded patients who lacked complete data for 3 months. One-to-one propensity score (PS) matching was performed before between-group comparison of survival rates (Kaplan-Meier method and log-rank test) and identification of factors affecting prognosis (Cox proportional-hazards regression analysis).

Results: We enrolled 621 and 71 patients undergoing HD and PD, respectively (overall mean ± standard deviation age: 74 ± 13 years); 20% had cardiovascular disease (CVD). The median follow-up period was 41 (interquartile range 24-66) months. Following PS matching, we analyzed 65 patients undergoing HD and PD each. The 5-year overall survival rates did not differ between the groups (P = 0.97). The PD group exhibited a better CVD-related survival rate (P = 0.03). PD yielded adjusted hazard ratios for all-cause and CVD-related mortality of 0.99 (95% confidence interval [CI] 0.49-1.99, P = 0.97) and 3.92 (95% CI 1.05-14.7, P = 0.04), respectively. Age (P < 0.001) and the use of a central venous catheter (CVC) at dialytic initiation (P = 0.02) were independent risks for all-cause mortality; whereas, only the use of a CVC (P = 0.01) was an independent risk for CVD-related mortality.

Conclusion: Although no differences were observed in overall survival, CVD-related survival may be better with dialytic initiation with PD than with HD.

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