title: Survival and time-to-transplantation of peritoneal dialysis versus hemodialysis for end-stage renal disease patients: competing-risks regression model in a single Italian center experience.
abstract: OBJECTIVE
  Despite several studies reporting similar outcomes for peritoneal dialysis (PD) and hemodialysis (HD), the former is underused worldwide, with a PD prevalence of 15% in Italy. In 2008, the Unit of Nephrology and Dialysis of the Healthcare Trust of the Autonomous Province of Trento implemented a successful PD program which has increased the proportion of PD incident patients from 7 to 47%. We aimed to assess the effect of this extensive use of PD by comparing HD and PD in terms of survival and time-to-transplantation.
  
  
  METHODS
  A total of 334 HD and 153 PD incident patients were enrolled between January 2008 and December 2014. After screening for exclusion criteria and propensity score matching, 279 HD and 132 PD patients were analyzed. Survival and time-to-transplantation were assessed by competing-risks regression models, using death and transplantation as primary and competing events.
  
  
  RESULTS
  Crude and adjusted regression models for survival revealed the absence of significant differences between HD and PD cumulative incidence functions (subhazard ratio: 1.09, p = 0.62 and 1.34, p = 0.10, respectively). Differently, crude and adjusted regression models for transplantation revealed a lower time-to-transplantation for PD versus HD patients (subhazard ratio: 2.34, p < 0.01, and 2.57, p < 0.01, respectively). The waiting time for placement in the transplant waiting list was longer in HD than PD patients (330 vs. 224 days, p < 0.01).
  
  
  CONCLUSIONS
  The extensive use of PD did not lead to any statistically significant difference in mortality. Furthermore, PD was associated with lower time to transplantation. PD may be a viable option for large-scale dialytic treatment in the advanced chronic kidney disease population.
authors.affiliation: Innovazione e Ricerca Clinica in Sanità - IRCS, Fondazione Bruno Kessler, Via Sommarive, 18, 38123, Trento, Italy. mrigoni@fbk.eu.
authors.forename: Marta
authors.identifier: http://orcid.org/0000-0002-0530-9491
authors.initials: M
authors.lastname: Rigoni
authors.affiliation: Innovazione e Ricerca Clinica in Sanità - IRCS, Fondazione Bruno Kessler, Via Sommarive, 18, 38123, Trento, Italy.|Dipartimento Salute e Solidarietà Sociale, Provincia Autonoma di Trento, Trento, Italy.
authors.forename: Emanuele
authors.initials: E
authors.lastname: Torri
authors.affiliation: Innovazione e Ricerca Clinica in Sanità - IRCS, Fondazione Bruno Kessler, Via Sommarive, 18, 38123, Trento, Italy.|Biotech, Dipartimento di Ingegneria Industriale, Università di Trento, Trento, Italy.
authors.forename: Giandomenico
authors.initials: G
authors.lastname: Nollo
authors.affiliation: U.O. Nefrologia, APSS Trento, Trento, Italy.
authors.forename: Diana
authors.initials: D
authors.lastname: Zarantonello
authors.affiliation: U.O. Nefrologia, APSS Trento, Trento, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Laudon
authors.affiliation: U.O. Nefrologia, APSS Trento, Trento, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Sottini
authors.affiliation: Direzione Sanitaria APSS Trento, Trento, Italy.
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Guarrera
authors.affiliation: U.O. Nefrologia, APSS Trento, Trento, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Brunori
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality; D057216:Propensity Score; D012044:Regression Analysis; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014850:Waiting Lists
keywords: Advanced chronic kidney disease; Competing-risks model; Dialysis survival; Hemodialysis; Kidney transplantation; Peritoneal dialysis