title: A comparative assessment of survival between propensity score-matched patients with peritoneal dialysis and hemodialysis in Taiwan.
abstract: Studies comparing mortality for Asian populations with end-stage renal disease (ESRD) on hemodialysis (HD) and peritoneal dialysis (PD) are limited. We compared mortality between patients treated with PD and HD in Taiwan, the population with the highest incidence of ESRD worldwide. Using the population-based insurance claims data of Taiwan from 1997 to 2006, we identified 4721 patients treated with PD and randomly selected 4721 patients treated with HD who were frequency-matched to the PD patients based on their propensity scores. In follow-up analyses we measured mortalities and hazard ratios associated with comorbidities in 2 different 5-year cohorts (1997-2001 and 2002-2006).In the 10-year period from 1997 to 2006, the overall mortality rates were similar in patients treated with PD and in patients treated with HD (12.0 vs. 11.7 per 100 person-years, respectively), with a PD-to-HD hazard ratio of 1.02 (95% confidence interval [CI], 0.96-1.08). In the first 5-year period (1997-2001), the hazard ratio for mortality was higher for PD (1.33; 95% CI, 1.21-1.46), but there was no difference between PD and HD in the 2002-2006 cohort. Of note, younger patients who received PD had better survival than younger patients who received HD; this was especially true for patients aged younger than 40 years.In summary, in this Asian population, no significant survival differences were noted between propensity score-matched PD and HD patients. The selection of a dialysis modality must be tailored to the individual patient. Studies in which patients who are appropriate for either modality are randomly assigned to HD or PD may provide helpful information to clinicians and patients.
authors.affiliation: From the Institute of Population Health Sciences (YKC, CC Hsu), National Health Research Institutes, Zhunan, Taiwan; Department of Public Health (YKC, PCC, FCS), Division of Nephrology (CC Huang), and Institute of Biostatistics (TCL), China Medical University and Hospital, Taichung, Taiwan; and Division of Nephrology (SJH), Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Kang
authors.initials: YK
authors.lastname: Chang
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Hsu
authors.forename: Shang-Jyh
authors.initials: SJ
authors.lastname: Hwang
authors.forename: Pei-Chun
authors.initials: PC
authors.lastname: Chen
authors.forename: Chiu-Chin
authors.initials: CC
authors.lastname: Huang
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D015331:Cohort Studies; D015897:Comorbidity; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016015:Logistic Models; D010530:Peritoneal Dialysis / Q000401:mortality*; D057216:Propensity Score; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome