title: In-Hospital Mortality in Cirrhotic Patients with End-Stage Renal Disease Treated with Hemodialysis Versus Peritoneal Dialysis: A Nationwide Study.
abstract: BACKGROUND
  Cirrhotic patients often develop end-stage renal disease (ESRD) requiring renal replacement therapy in the form of hemodialysis (HD) or peritoneal dialysis (PD). Studies comparing the outcomes and difference in in-hospital mortality between these 2 groups, particularly among those with ascites, are sparse. We set our objective to determine the dialysis modality with a better in-hospital survival rate among cirrhotic patients with ESRD (ESRD-cirrhosis).
  
  
  METHODS
  Data was extracted from the 2005 to 2012 Nationwide Inpatient Sample (NIS). Using propensity score matching, ESRD-cirrhosis patients on PD were matched with patients on HD at a 1:1 ratio. Another subgroup analysis of ESRD-cirrhosis patients with ascites was performed using the same matching algorithm. Analyses were performed using SAS version 9.3 (SAS Institute, Cary, NC, USA).
  
  
  RESULTS
  Among 26,135 cirrhotic patients with incident ESRD, 25,686 (98.3%) and 449 (1.7%) were initiated on HD and PD, respectively, during the hospitalization. There was a nonsignificant mortality difference between the ESRD-cirrhosis patients treated with PD and those treated with HD. In a subgroup analysis of these patients with ascites, 18 patients underwent PD while 1,878 patients required HD. Also, PD had a significantly lower in-hospital mortality compared with HD in this subgroup (0% vs 26.67%,p= 0.03). Mean length of stay for those who received HD was 8.34 days compared with 7.06 days for the PD group (p< 0.0001). Similarly, mean hospital charges were greater for those who had HD compared with PD ($74,501 vs $57,460;p< 0.001).
  
  
  CONCLUSIONS
  Cirrhotic patients with ESRD and ascites who undergo PD have a significantly lower mortality than those who are started on HD. However PD is rarely initiated for ESRD in cirrhotic patients with ascites during hospitalization in the United States. Due to the potential advantages of PD, nephrologists should encourage PD when selecting dialysis modality in this subgroup of patients whenever possible.
authors.affiliation: Department of Nephrology, MedStar Georgetown University, Washington, DC, USA; Kidney Care Consultants, Memphis, TN, USA mknader@hotmail.com.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Nader
authors.affiliation: Department of Nephrology, MedStar Georgetown University, Washington, DC, USA; Kidney Care Consultants, Memphis, TN, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Aguilar
authors.affiliation: Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USA.
authors.forename: Prabin
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Cardiology, Albert Einstein Medical Center, Einstein Institute for Heart and Vascular Health, Philadelphia, PA, USA.
authors.forename: Parasuram
authors.initials: P
authors.lastname: Krishnamoorthy
authors.affiliation: Department of Nephrology, MedStar Georgetown University, Washington, DC, USA; Kidney Care Consultants, Memphis, TN, USA.
authors.forename: Dragoi
authors.initials: D
authors.lastname: Serban
authors.affiliation: Department of Nephrology, MedStar Georgetown University, Washington, DC, USA; Kidney Care Consultants, Memphis, TN, USA.
authors.forename: Judit
authors.initials: J
authors.lastname: Gordon-Cappitelli
authors.affiliation: Department of Nephrology, MedStar Georgetown University, Washington, DC, USA; Kidney Care Consultants, Memphis, TN, USA.
authors.forename: Wen
authors.initials: W
authors.lastname: Shen
authors.affiliation: Department of Nephrology, MedStar Georgetown University, Washington, DC, USA; Kidney Care Consultants, Memphis, TN, USA.
authors.forename: Chanigan
authors.initials: C
authors.lastname: Nilubol
authors.affiliation: Washington Veterans Affairs Medical Center, Washington, DC, USA.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Nephrology, MedStar Georgetown University, Washington, DC, USA; Kidney Care Consultants, Memphis, TN, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Lipkowitz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis; D057216:Propensity Score; D006435:Renal Dialysis; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: ESRD; HD; PD; Peritoneal dialysis; cirrhotic; hemodialysis