Dialysis Modality and Mortality in the Elderly: A Meta-Analysis.
OBJECTIVE
Identifying the appropriate choice between hemodialysis (HD) and peritoneal dialysis (PD) is an unresolved issue in elderly patients with ESRD, who are at high risk for death but have a low chance of receiving kidney transplantation.


METHODS
Data on 13,065 incident dialysis Korean patients (age≥65 years) receiving HD (n=10,675) or PD (n=2390) were obtained from the Korean Health Insurance dataset. Multiple statistical approaches, including the multivariate Cox model, were used to compare mortality between Korean patients receiving PD and those receiving HD. Subsequently, meta-analysis of previous comparison studies (published since the year 2000; population-based studies) and the Korean dataset was performed.


RESULTS
During a mean duration of 1.8±1.3 years (maximum of 5 years), the Korean PD group had a higher mortality rate than the Korean HD group (hazard ratio [HR], 1.20 [95% confidence interval (95% CI), 1.13 to 1.28]; P<0.001 by multivariate Cox model). The discrepancy between the two modalities was greater in the presence of certain conditions, such as diabetes mellitus or longer dialysis duration. In the meta-analysis, 15 studies involving >631,421 elderly patients were reviewed. Compared with HD, the pooled HR with PD was 1.10 (95% CI, 1.01 to 1.20). When the meta-analysis was stratified by confounding factors, the survival benefit from HD was particularly strong in subgroups that had diabetes mellitus, had long dialysis duration (>1 year), or contained cohorts starting dialysis in the 1990s.


CONCLUSIONS
A meta-analysis that included results in Korean patients suggests a higher risk for death in elderly patients receiving PD than in those receiving HD.
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea;
Seung Seok
SS
Han
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea;
Jae Yoon
JY
Park
Medical Research Collaborating Center and.
Soohee
S
Kang
Department of Public Health, Graduate School, Korea University, Seoul, Korea;
Kyoung Hoon
KH
Kim
Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea;
Dong-Ryeol
DR
Ryu
Department of Internal Medicine, Wonkwang University College of Medicine, Sanbon Hospital, Gyeonggi-do, Korea; and.
Hyunwook
H
Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea;
Kwon Wook
KW
Joo
Kidney Research Institute, Seoul National University Hospital, Seoul, Korea; Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Korea.
Chun Soo
CS
Lim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea;
Yon Su
YS
Kim
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea; Kidney Research Institute, Seoul National University Hospital, Seoul, Korea; dkkim73@gmail.com.
Dong Ki
DK
Kim
D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D008297:Male; D015999:Multivariate Analysis; D018579:Patient Selection; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality*; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D056910:Republic of Korea / Q000453:epidemiology; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
dialysis modality; elderly; hemodialysis; mortality; peritoneal dialysis