Relative survival of peritoneal dialysis and haemodialysis patients: effect of cohort and mode of dialysis initiation

Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was performed to investigat...

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Published in:PloS one 2014-03, Vol.9 (3), p.e90119
Main Authors: Heaf, James G, Wehberg, Sonja
Format: Article
Language:English
Subjects:
Adolescent
Adult
Age
Aged
Aged, 80 and over
Analysis
Child
Child, Preschool
Chronic kidney failure
Cohort Studies
Comorbidity
Confidence Intervals
Denmark - epidemiology
Diabetes
Diabetic nephropathies
Diabetic nephropathy
Epidemiology
Female
Health risk assessment
Hemodialysis
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Kidney cancer
Kidney diseases
Male
Medical prognosis
Medical research
Medicine
Middle Aged
Mortality
Nephrology
Patient outcomes
Patients
Peritoneal dialysis
Peritoneal Dialysis - mortality
Prognosis
Proportional Hazards Models
Survival
Time Factors
Young Adult
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description Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was performed to investigate (1) whether, and if so, how, PD and HD prognosis had changed in recent years, (2) whether a potential survival advantage of PD versus HD is constant over dialysis duration, and (3) whether differences in prognosis could be explained by patient age, renal diagnosis of diabetic nephropathy, or mode of dialysis initiation. 12095 patients starting dialysis therapy between 1990 and 2010 in Denmark were studied. Prognosis was assessed according to initial dialysis modality on an intention-to-treat basis, censored for transplantation. Results were adjusted for age, sex, renal diagnosis, Charlson Comorbidity Index (CCI), and mode of dialysis initiation. Overall adjusted prognosis improved by 34% (HD 30%, PD 42%). PD prognosis relative to HD improved, and was 16% better at the end of the period. Final PD prognosis improved consistently from 1990-99 to 2000-10 in all subgroups. PD was associated with a significant initial survival advantage, both overall and for all subgroups For the latter cohort, overall PD prognosis was better than HD for the first 4 years, after which it was insignificantly worse. The initial survival advantage was also present in a subgroup analysis of patients with early & routine ESRD initiation. Dialysis survival has increased during the past 20 years. PD survival since 2000 has been better than HD, overall and for all subgroups. The difference in survival is not explained by mode of dialysis initiation.
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Final PD prognosis improved consistently from 1990-99 to 2000-10 in all subgroups. PD was associated with a significant initial survival advantage, both overall and for all subgroups For the latter cohort, overall PD prognosis was better than HD for the first 4 years, after which it was insignificantly worse. The initial survival advantage was also present in a subgroup analysis of patients with early &amp; routine ESRD initiation. Dialysis survival has increased during the past 20 years. PD survival since 2000 has been better than HD, overall and for all subgroups. 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subjects Adolescent
Adult
Age
Aged
Aged, 80 and over
Analysis
Child
Child, Preschool
Chronic kidney failure
Cohort Studies
Comorbidity
Confidence Intervals
Denmark - epidemiology
Diabetes
Diabetic nephropathies
Diabetic nephropathy
Epidemiology
Female
Health risk assessment
Hemodialysis
Humans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Kidney cancer
Kidney diseases
Male
Medical prognosis
Medical research
Medicine
Middle Aged
Mortality
Nephrology
Patient outcomes
Patients
Peritoneal dialysis
Peritoneal Dialysis - mortality
Prognosis
Proportional Hazards Models
Survival
Time Factors
Young Adult
title Relative survival of peritoneal dialysis and haemodialysis patients: effect of cohort and mode of dialysis initiation
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