A comparison of mortality between patients treated with hemodialysis and peritoneal dialysis.
Patients with ESRD treated with dialysis have a high mortality rate. Controversy exists as to whether this high mortality rate is affected by modality choice. The purpose of this epidemiologic study was to compare mortality in prevalent hemodialysis-treated (HD) and peritoneal dialysis-treated (PD) patients in a large national sample, adjusting for demographic characteristics. Data were obtained from the U.S. Renal Data System for patients prevalent on January 1 of the years 1987, 1988, and 1989, each with 1 yr of follow-up. Patients were censored at transplantation. Death rates per 100 patient years were compared between HD and PD, adjusting for age, race, gender, cause of ESRD (diabetes versus nondiabetes) and < 1 yr or > 1 yr of prior ESRD, by the use of Poisson regression. There were 42,372 deaths occurring over 170,700 patient years at risk. On average, prevalent patients treated with PD had a 19% higher adjusted mortality risk (relative risk (RR) = 1.19; P < 0.001) than did those treated with HD. This risk was found to be insignificant (P > 0.05) and small for ages < 55 and increasingly large and significant for ages > 55 yr. It was accentuated in diabetics (RR = 1.38; P < 0.001) but was also present in nondiabetics (RR = 1.11; P < 0.001). Although present in both males and females, this risk was accentuated in females (RR = 1.30 versus 1.11; both P < 0.001). In this national study of prevalent U.S. dialysis patients, treatment assignment to PD was associated with a 19% higher all-cause mortality rate than HD.(ABSTRACT TRUNCATED AT 250 WORDS)
Bloembergen
W E
WE
Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, USA.
Port
F K
FK
Mauger
E A
EA
Wolfe
R A
RA
D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D015995:Prevalence; D012044:Regression Analysis; D006435:Renal Dialysis / Q000401:mortality*; D012306:Risk; D014481:United States / Q000453:epidemiology