Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease.
BACKGROUND
The annual payer costs for patients treated with peritoneal dialysis (PD) are lower than with hemodialysis (HD), but in 2007, only 7% of dialysis patients in the United States were treated with PD. Since 1996, there has been no change in the first-year mortality of HD patients, but both short- and long-term outcomes of PD patients have improved.


METHODS
Data from the US Renal Data System were examined for secular trends in survival among patients treated with HD and PD on day 90 of end-stage renal disease (HD, 620 020 patients; PD, 64 406 patients) in three 3-year cohorts (1996-1998, 1999-2001, and 2002-2004) for up to 5 years of follow-up using a nonproportional hazards marginal structural model with inverse probability of treatment and censoring weighting.


RESULTS
There was a progressive attenuation in the higher risk for death seen in patients treated with PD in earlier cohorts; for the 2002-2004 cohort, there was no significant difference in the risk of death for HD and PD patients through 5 years of follow-up. The median life expectancy of HD and PD patients was 38.4 and 36.6 months, respectively. Analyses in 8 subgroups based on age (<65 and ≥65 years), diabetic status, and baseline comorbidity (none and ≥1) showed greater improvement in survival among patients treated with PD relative to HD at all follow-up periods.


CONCLUSIONS
In the most recent cohorts, patients who began treatment with HD or PD have similar outcomes.
Mehrotra
Rajnish
R
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA. rmehrotra@labiomed.org
Chiu
Yi-Wen
YW
Kalantar-Zadeh
Kamyar
K
Bargman
Joanne
J
Vonesh
Edward
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008017:Life Expectancy / Q000639:trends; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000706:statistics & numerical data*; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult