title: Peritoneal Dialysis is Associated With A Better Survival in Cirrhotic Patients With Chronic Kidney Disease.
abstract: Peritoneal dialysis (PD) can be an ideal treatment in cirrhotic patients with ascites and chronic kidney disease stage 5 (CKD 5D) who require dialysis. The survival of cirrhotic patients with CKD 5D on PD, however, is not clear. We compared the survival of cirrhotic patients with CKD 5D on PD and the survival of those on HD. Two datasets including a cohort study of China Medical University Hospital (CMUH) from 2004 to 2013 and the Longitudinal National Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) of Taiwan from 1996 to 2011 were analyzed. The survival of cirrhotic patients on PD and the propensity score matched cirrhotic patients on HD were analyzed using Cox proportional hazards regression. In CMUH cohort of 85 PD and 340 HD patients, the all-cause mortality was lower in PD patients compared to it in HD patients (hazard ratio [HR]: 0.48, 95% confidence interval [CI]: 0.31-0.74, P < 0.01) after adjustments for confounders. The severity of liver cirrhosis defined by Child-Turcotte-Pugh (CTP) class (P < 0.01) was independently associated with all-cause mortality. The model for end-stage liver disease (MELD) score, however, was not associated with all-cause mortality. In the LHID-CIP cohort of 285 PD and 1140 HD patients, the HR of all-cause mortality in PD patients was 0.61 (95% CI: 0.47 - 0.79, P < 0.01), as compared with HD patients. PD in cirrhotic patients who need dialysis is associated with lower all-cause mortality than HD is. This association is independent of patients' comorbidity, severity of liver cirrhosis, and serum albumin levels.
authors.affiliation: From the Division of Nephrology and Kidney Institute, Department of Internal Medicine (C-CY, W-SM, L-CC, C-CT, L-JH, W-IK, H-CC); College of Medicine (C-CY, W-SM, L-CC, C-CT, L-JH, W-IK, H-LC, H-CC); Division of Cardiology, Department of Internal Medicine China Medical University Hospital (H-LC); Department of Public Health (M-CH); Management Office for Health Data, China Medical University and Hospital, 91 Hsueh-Shih Road (M-CH); Department of Health Risk Management, College of Public Health (C-CJ); and Department of Medical Research, China Medical University Hospital, Taichung 40402, Taiwan (C-CJ).
authors.forename: Che-Yi
authors.initials: CY
authors.lastname: Chou
authors.forename: Shu-Ming
authors.initials: SM
authors.lastname: Wang
authors.forename: Chih-Chia
authors.initials: CC
authors.lastname: Liang
authors.forename: Chiz-Tzung
authors.initials: CT
authors.lastname: Chang
authors.forename: Jiung-Hsiun
authors.initials: JH
authors.lastname: Liu
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.forename: Lien-Cheng
authors.initials: LC
authors.lastname: Hsiao
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.forename: Chi-Jung
authors.initials: CJ
authors.lastname: Chung
authors.forename: Chiu-Ching
authors.initials: CC
authors.lastname: Huang
mesh_terms: D000368:Aged; D001201:Ascites / Q000209:etiology; D002423:Cause of Death; D002681:China; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D057216:Propensity Score; D006435:Renal Dialysis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate; D013624:Taiwan
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