title: Effects of comorbid and demographic factors on dialysis modality choice and related patient survival in Europe.
abstract: BACKGROUND
  The mean age of patients starting dialysis increased over the years, as has the proportion of patients with diabetes mellitus, ischaemic heart disease, peripheral vascular disease (PVD), cerebrovascular disease (CD) and malignancy. We assessed dialysis modality choice within subgroups of patients with these comorbidities and in different age categories and subsequently evaluated the association between modality choice and patient survival in these subgroups.
  
  
  METHODS
  Seven European renal registries participating in the ERA-EDTA Registry provided data from 15,828 incident peritoneal dialysis (PD) and haemodialysis (HD) patients (1998-2006) with available comorbidity data. The likelihood to receive PD rather than HD was assessed with logistic regression and 3-year survival on PD versus HD was evaluated using Cox regression.
  
  
  RESULTS
  Besides large international variations in the likelihood to receive PD, we found that elderly patients and patients with PVD, CD, malignancy and multiple comorbidities were significantly less likely to receive PD than HD. Overall patients starting on PD had survival benefits [adjusted hazard ratio (HR(adj)) 0.82 (0.75-0.90)], especially patients without comorbidity [HR(adj) 0.65 (0.53-0.80)] or those with malignancy [HR(adj) 0.73 (0.56-0.94)]. In males, survival benefits of PD were independent of diabetic status. Conversely, diabetic females tended to have increased mortality risk on PD [HR(adj) 1.16 (0.93-1.44)], especially if they were >70 years [HR(adj) 1.55 (1.15-2.08)].
  
  
  CONCLUSIONS
  In general, modality choice was consistent with expected survival. However, elderly patients, non-diabetic patients and those with malignancy were less likely to receive PD, even though they had decreased mortality risk on PD. Also, although a survival benefit of PD was found for male patients without comorbidity, HD was just as likely to be the chosen dialysis modality as was PD for these patients.
authors.affiliation: ERA–EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.w.vandeluijtgaarden@amc.nl.
authors.forename: Moniek W M
authors.initials: MW
authors.lastname: van de Luijtgaarden
authors.forename: Marlies
authors.initials: M
authors.lastname: Noordzij
authors.forename: Vianda S
authors.initials: VS
authors.lastname: Stel
authors.forename: Pietro
authors.initials: P
authors.lastname: Ravani
authors.forename: Faical
authors.initials: F
authors.lastname: Jarraya
authors.forename: Frederic
authors.initials: F
authors.lastname: Collart
authors.forename: Staffan
authors.initials: S
authors.lastname: Schön
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Leivestad
authors.forename: Heidi
authors.initials: H
authors.lastname: Puttinger
authors.forename: Christoph
authors.initials: C
authors.lastname: Wanner
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D003710:Demography; D005060:Europe; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D011379:Prognosis; D012042:Registries; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult