Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease

Arch Intern Med. 2011 Jan 24;171(2):110-8. doi: 10.1001/archinternmed.2010.352. Epub 2010 Sep 27.

Abstract

Background: The annual payer costs for patients treated with peritoneal dialysis (PD) are lower than with hemodialysis (HD), but in 2007, only 7% of dialysis patients in the United States were treated with PD. Since 1996, there has been no change in the first-year mortality of HD patients, but both short- and long-term outcomes of PD patients have improved.

Methods: Data from the US Renal Data System were examined for secular trends in survival among patients treated with HD and PD on day 90 of end-stage renal disease (HD, 620 020 patients; PD, 64 406 patients) in three 3-year cohorts (1996-1998, 1999-2001, and 2002-2004) for up to 5 years of follow-up using a nonproportional hazards marginal structural model with inverse probability of treatment and censoring weighting.

Results: There was a progressive attenuation in the higher risk for death seen in patients treated with PD in earlier cohorts; for the 2002-2004 cohort, there was no significant difference in the risk of death for HD and PD patients through 5 years of follow-up. The median life expectancy of HD and PD patients was 38.4 and 36.6 months, respectively. Analyses in 8 subgroups based on age (<65 and ≥65 years), diabetic status, and baseline comorbidity (none and ≥1) showed greater improvement in survival among patients treated with PD relative to HD at all follow-up periods.

Conclusion: In the most recent cohorts, patients who began treatment with HD or PD have similar outcomes.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Cohort Studies
  • Comorbidity
  • Diabetes Mellitus / mortality
  • Female
  • Follow-Up Studies
  • Humans
  • Kidney Failure, Chronic / mortality*
  • Kidney Failure, Chronic / therapy*
  • Life Expectancy / trends
  • Male
  • Middle Aged
  • Peritoneal Dialysis / statistics & numerical data*
  • Registries / statistics & numerical data
  • Renal Dialysis / statistics & numerical data
  • Treatment Outcome
  • United States
  • Young Adult