title: Survival advantage of hemodialysis relative to peritoneal dialysis in patients with end-stage renal disease and congestive heart failure.
abstract: Peritoneal dialysis (PD) has been proposed as a therapeutic option for patients with end-stage renal disease and associated congestive heart failure (CHF). Here, we compare mortality risks in these patients by dialysis modality by including all patients who started planned chronic dialysis with associated congestive heart failure and were prospectively enrolled in the French REIN Registry. Survival was compared between 933 PD and 3468 hemodialysis (HD) patients using a Kaplan-Meier model, Cox regression, and propensity score analysis. The patients were followed from their first dialysis session and stratified by modality at day 90 or last modality if death occurred prior. There was a significant difference in the median survival time of 20.4 months in the PD group and 36.7 months in the HD group (hazard ratio, 1.55). After correction for confounders, the adjusted hazard ratio for death in PD compared to the HD patients remained significant at 1.48. Subgroup analyses showed that the results were not changed with regard to the New York Heart Association stage, age strata, or estimated glomerular filtration rate strata at first renal replacement therapy. The use of propensity score did not change results (adjusted hazard ratio, 1.55). Thus, mortality risk was higher with PD than with HD among incident patients with end-stage renal disease and congestive heart failure. These results may help guide clinical decisions and also highlight the need for randomized clinical trials.
authors.affiliation: Department of Nephrology, Hospices Civils de Lyon, Lyon-Sud University Hospital, Pierre Benite, France; Pole IMER des Hospices Civils de Lyon, Lyon, France. Electronic address: florence.sens@chu-lyon.fr.
authors.forename: Florence
authors.initials: F
authors.lastname: Sens
authors.affiliation: Pole IMER des Hospices Civils de Lyon, Lyon, France; University Lyon I, Villeurbanne, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Schott-Pethelaz
authors.affiliation: Department of Nephrology, Hospices Civils de Lyon, Lyon-Sud University Hospital, Pierre Benite, France; University Lyon I, Villeurbanne, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Labeeuw
authors.affiliation: Pole IMER des Hospices Civils de Lyon, Lyon, France; University Lyon I, Villeurbanne, France.
authors.forename: Cyrille
authors.initials: C
authors.lastname: Colin
authors.affiliation: Department of Nephrology, Hospices Civils de Lyon, Lyon-Sud University Hospital, Pierre Benite, France; UMR 5558, University Lyon 1, CNRS, Equipe Biostatistiques Santé, Villeurbanne, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Villar
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005602:France; D006333:Heart Failure / Q000150:complications / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome