title: Impact of dialysis modality on the survival of end-stage renal disease patients with or without cardiovascular disease.
abstract: BACKGROUND
  The question of which modality, either peritoneal dialysis (PD) or hemodialysis (HD), confers the survival advantage for incident ESRD patients with pre-existing cardiovascular disease (CVD) remains unanswered.
  
  
  METHODS
  Data used in this study were extracted from the National Health Insurance Research Database in Taiwan. From 1997 to 2007, incident ESRD patients who underwent dialysis longer than three months were selected. The established dialysis modality at day 90 was used to analyze the impact of dialysis modality on survival. For each PD patient indentified, five HD patients matched for age, sex, and year in which the patients received their first dialysis treatment were randomly selected. Finally, a total of 35 664 patients including 29 720 HD patients and 5944 PD patients were selected. The primary outcome was death after commencing dialysis.
  
  
  RESULTS
  For diabetic ESRD patients with or without coronary artery disease (CAD) or congestive heart failure (CHF), patients receiving PD had inferior survival compared with those receiving HD (P<.001, adjusted HR=1.34 to 1.43). For nondiabetic patients with CAD or CHF, patients receiving PD also had inferior survival compared with those receiving HD (adjusted HR=1.30, CI: 1.08 to 1.57; adjusted HR=1.31, CI: 1.11 to 1.55). For nondiabetic ESRD patients without CAD or CHF, there was no statistically significant difference in survival between PD and HD (adjusted HR=1.00, CI: 0.92 to 1.09; adjusted HR=0.98, CI: 0.90 to 1.07).
  
  
  CONCLUSIONS
  PD was associated with poorer survival among ESRD patients with CVD or diabetes mellitus compared with HD.
authors.affiliation: Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.forename: Pei-Tseng
authors.initials: PT
authors.lastname: Kung
authors.forename: Wei-Yin
authors.initials: WY
authors.lastname: Kuo
authors.forename: Wen-Chen
authors.initials: WC
authors.lastname: Tsai
authors.forename: Yi-Chih
authors.initials: YC
authors.lastname: Chang
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Liang
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.forename: Hung-Chieh
authors.initials: HC
authors.lastname: Yeh
authors.forename: Shu-Ming
authors.initials: SM
authors.lastname: Wang
authors.forename: Feng-Rong
authors.initials: FR
authors.lastname: Chuang
authors.forename: Kwua-Yun
authors.initials: KY
authors.lastname: Wang
authors.forename: Ching-Yuang
authors.initials: CY
authors.lastname: Lin
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D016009:Chi-Square Distribution; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality*; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome