title: Survival of propensity matched incident peritoneal and hemodialysis patients in a United States health care system.
abstract: We sought to compare survival among incident peritoneal dialysis (PD) patients to matched hemodialysis (HD) patients who received pre-dialysis care, including permanent dialysis access placement. Patients starting PD were propensity matched to those starting HD. HD patients who used a central venous catheter during the first 90 days of dialysis were excluded. Stratified Cox proportional hazards models were used to compare patient survival using both intent-to-treat and as-treated analyses. In the intent-to-treat analysis, patients were followed from the date of first dialysis until death and censored at the earliest of the following: renal transplantation, death, renal recovery, loss to follow-up or study end. In the as-treated analysis, patients were also censored at the time of modality change. A total of 1003 matched pairs were obtained from 11,301 incident patients (10,298 HD and 1003 PD). The cumulative hazard ratio for death at one year was 2.38 (95% CI 1.68-3.40) and 2.10 (1.50-2.94) for HD relative to PD patients in the as-treated and intent-to-treat analyses, respectively. The cumulative risk of death, as estimated by the cumulative hazard ratio, favored PD for almost up to 3 years of follow-up in the as-treated analysis and nearly 2 years of follow-up in the intent-to-treat analysis with no differences thereafter. The higher adjusted rate of death observed for HD patients cannot be attributed to initial use of central venous catheters or lack of pre-dialysis care.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Southern California Permanente Medical Group, Los Angeles, California, USA.
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Kumar
authors.affiliation: Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California, USA.
authors.forename: Margo A
authors.initials: MA
authors.lastname: Sidell
authors.affiliation: Research and Evaluation, Southern California Permanente Medical Group, Pasadena, California, USA.
authors.forename: Jason P
authors.initials: JP
authors.lastname: Jones
authors.affiliation: Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
authors.forename: Edward F
authors.initials: EF
authors.lastname: Vonesh
mesh_terms: D000328:Adult; D000368:Aged; D002140:California / Q000453:epidemiology; D005260:Female; D006279:Health Maintenance Organizations; D006801:Humans; D057194:Intention to Treat Analysis; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012042:Registries; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome