Survival advantage of peritoneal dialysis relative to hemodialysis in the early period of incident dialysis patients: a nationwide prospective propensity-matched study in Korea

Ji-Young Choi, Hye Min Jang, Jongha Park, Yon Su Kim, Shin-Wook Kang, Chul Woo Yang, Nam-Ho Kim, Jang-Hee Cho, Sun-Hee Park, Chan-Duck Kim, Yong-Lim Kim, Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators, J Y Do, S H Song, S H Kim, Y H Kim, J S Lee, H J Jin, C S Lim, J H Chang, T H Yoo, J T Park, H C Park, T I Chang, D R Ryu, D J Oh, Y S Chang, Y O Kim, S H Kim, D C Jin, Y K Kim, W Kim, K W Lee, C S Lee, Ji-Young Choi, Hye Min Jang, Jongha Park, Yon Su Kim, Shin-Wook Kang, Chul Woo Yang, Nam-Ho Kim, Jang-Hee Cho, Sun-Hee Park, Chan-Duck Kim, Yong-Lim Kim, Clinical Research Center for End Stage Renal Disease (CRC for ESRD) Investigators, J Y Do, S H Song, S H Kim, Y H Kim, J S Lee, H J Jin, C S Lim, J H Chang, T H Yoo, J T Park, H C Park, T I Chang, D R Ryu, D J Oh, Y S Chang, Y O Kim, S H Kim, D C Jin, Y K Kim, W Kim, K W Lee, C S Lee

Abstract

Background: The impact of dialysis modality on survival is still somewhat controversial. Given possible differences in patients' characteristics and the cause and rate of death in different countries, the issue needs to be evaluated in Korean cohorts.

Methods: A nationwide prospective observational cohort study (NCT00931970) was performed to compare survival between peritoneal dialysis (PD) and hemodialysis (HD). A total of 1,060 end-stage renal disease patients in Korea who began dialysis between September 1, 2008 and June 30, 2011 were followed through December 31, 2011.

Results: The patients (PD, 30.6%; HD, 69.4%) were followed up for 16.3 ± 7.9 months. PD patients were significantly younger, less likely to be diabetic, with lower body mass index, and larger urinary volume than HD patients. Infection was the most common cause of death. Multivariate Cox regression with the entire cohort revealed that PD tended to be associated with a lower risk of death compared to HD [hazard ratio (HR) 0.63, 95% confidence interval (CI) 0.36-1.08]. In propensity score matched pairs (n=278 in each modality), cumulative survival probabilities for PD and HD patients were 96.9% and 94.1% at 12 months (P=0.152) and 94.3% and 87.6% at 24 months (P=0.022), respectively. Patients on PD had a 51% lower risk of death compared to those on HD (HR 0.49, 95% CI 0.25-0.97).

Conclusions: PD exhibits superior survival to HD in the early period of dialysis, even after adjusting for differences in the patients' characteristics between the two modalities. Notably, the most common cause of death was infection in this Korean cohort.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Survival probability from day 90…
Figure 1. Survival probability from day 90 by dialysis modality and cumulative incidence curves for death and transplantation.
(A) Propensity-score matching of patients. (B) Cumulative incidence curves for death and transplantation, taking competing risks into account.
Figure 2. Kaplan-Meier curve according to age…
Figure 2. Kaplan-Meier curve according to age and presence of diabetes in propensity-score matched population.
(A) age ≥65 years with diabetes; (B) ≥65 years without diabetes; (C)

Figure 3. Kaplan-Meier curve according to sex…

Figure 3. Kaplan-Meier curve according to sex and presence of diabetes in propensity-score matched population.

Figure 3. Kaplan-Meier curve according to sex and presence of diabetes in propensity-score matched population.
(A) diabetic male; (B) non-diabetic male; (C) diabetic female; (D) non-diabetic female A Male, DM B Male, non-DM C Female, DM D Female, non-DM.
Figure 3. Kaplan-Meier curve according to sex…
Figure 3. Kaplan-Meier curve according to sex and presence of diabetes in propensity-score matched population.
(A) diabetic male; (B) non-diabetic male; (C) diabetic female; (D) non-diabetic female A Male, DM B Male, non-DM C Female, DM D Female, non-DM.

References

    1. Foley RN, Collins AJ (2013) The USRDS: what you need to know about what it can and can’t tell us about ESRD. Clin J Am Soc Nephrol 8: 845–851.
    1. Grace BS, Clayton P, McDonald SP (2012) Increases in renal replacement therapy in Australia and New Zealand: understanding trends in diabetic nephropathy. Nephrology (Carlton) 17: 76–84.
    1. Jin DC (2011) Current status of dialysis therapy in Korea. Korean J Intern Med 26: 123–131.
    1. Bruns FJ, Seddon P, Saul M, Zeidel ML (1998) The cost of caring for end-stage kidney disease patients: an analysis based on hospital financial transaction records. J Am Soc Nephrol 9: 884–890.
    1. Stack AG (2002) Determinants of modality selection among incident US dialysis patients: results from a national study. J Am Soc Nephrol 13: 1279–1287.
    1. Jaar BG, Coresh J, Plantinga LC, Fink NE, Klag MJ, et al. (2005) Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease. Ann Intern Med 143: 174–183.
    1. Termorshuizen F, Korevaar JC, Dekker FW, Van Manen JG, Boeschoten EW, et al. (2003) Hemodialysis and peritoneal dialysis: comparison of adjusted mortality rates according to the duration of dialysis: analysis of The Netherlands Cooperative Study on the Adequacy of Dialysis 2. J Am Soc Nephrol 14: 2851–2860.
    1. Liem YS, Wong JB, Hunink MG, de Charro FT, Winkelmayer WC (2007) Comparison of hemodialysis and peritoneal dialysis survival in The Netherlands. Kidney Int 71: 153–158.
    1. Weinhandl ED, Foley RN, Gilbertson DT, Arneson TJ, Snyder JJ, et al. (2010) Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol 21: 499–506.
    1. Mehrotra R, Chiu YW, Kalantar-Zadeh K, Bargman J, Vonesh E (2011) Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med 171: 110–118.
    1. Mehrotra R, Kermah D, Fried L, Kalantar-Zadeh K, Khawar O, et al. (2007) Chronic peritoneal dialysis in the United States: declining utilization despite improving outcomes. J Am Soc Nephrol 18: 2781–2788.
    1. Korevaar JC, Feith GW, Dekker FW, van Manen JG, Boeschoten EW, et al. (2003) Effect of starting with hemodialysis compared with peritoneal dialysis in patients new on dialysis treatment: a randomized controlled trial. Kidney Int 64: 2222–2228.
    1. McDonald SP, Marshall MR, Johnson DW, Polkinghorne KR (2009) Relationship between dialysis modality and mortality. J Am Soc Nephrol 20: 155–163.
    1. Suzuki K, Konta T, Ichikawa K, Ikeda A, Niino H, et al. (2012) Comparison of Mortality between Japanese Peritoneal Dialysis and Hemodialysis Patients: A 5-Year Multicenter Follow-Up Study. Int J Nephrol 2012: 231018.
    1. Austin PC, Grootendorst P, Anderson GM (2007) A comparison of the ability of different propensity score models to balance measured variables between treated and untreated subjects: a Monte Carlo study. Stat Med 26: 734–753.
    1. Quinn RR, Hux JE, Oliver MJ, Austin PC, Tonelli M, et al. (2011) Selection bias explains apparent differential mortality between dialysis modalities. J Am Soc Nephrol 22: 1534–1542.
    1. Collins AJ, Hao W, Xia H, Ebben JP, Everson SE, et al. (1999) Mortality risks of peritoneal dialysis and hemodialysis. Am J Kidney Dis 34: 1065–1074.
    1. Fenton SS, Schaubel DE, Desmeules M, Morrison HI, Mao Y, et al. (1997) Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis 30: 334–342.
    1. Heaf JG, Lokkegaard H, Madsen M (2002) Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant 17: 112–117.
    1. Lukowsky LR, Mehrotra R, Kheifets L, Arah OA, Nissenson AR, et al. (2013) Comparing mortality of peritoneal and hemodialysis patients in the first 2 years of dialysis therapy: a marginal structural model analysis. Clin J Am Soc Nephrol 8: 619–628.
    1. van de Luijtgaarden MW, Noordzij M, Stel VS, Ravani P, Jarraya F, et al. (2011) Effects of comorbid and demographic factors on dialysis modality choice and related patient survival in Europe. Nephrol Dial Transplant 26: 2940–2947.
    1. Soucie JM, McClellan WM (1996) Early death in dialysis patients: risk factors and impact on incidence and mortality rates. J Am Soc Nephrol 7: 2169–2175.
    1. Winkelmayer WC, Glynn RJ, Mittleman MA, Levin R, Pliskin JS, et al. (2002) Comparing mortality of elderly patients on hemodialysis versus peritoneal dialysis: a propensity score approach. J Am Soc Nephrol 13: 2353–2362.
    1. Polkinghorne KR, McDonald SP, Atkins RC, Kerr PG (2004) Vascular access and all-cause mortality: a propensity score analysis. J Am Soc Nephrol 15: 477–486.
    1. Dhingra RK, Young EW, Hulbert-Shearon TE, Leavey SF, Port FK (2001) Type of vascular access and mortality in U.S. hemodialysis patients. Kidney Int 60: 1443–1451.
    1. Moist LM, Chang SH, Polkinghorne KR, McDonald SP (2007) Trends in hemodialysis vascular access from the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) 2000 to 2005. Am J Kidney Dis 50: 612–621.
    1. Ja-Yong Park, Ji-Young Choi, Sun-Hee Park, Chan-Duck Kim, Sung-Ho Kim, et al... (2010) Pattern of Vascular Access in Hemodialysis patients: Cross-sectional analysis of Clinical Research Center for End Stage Renal Disease in Korea. J Am Soc Nephrol, Kidney Week Abstract.
    1. Sanabria M, Munoz J, Trillos C, Hernandez G, Latorre C, et al... (2008) Dialysis outcomes in Colombia (DOC) study: a comparison of patient survival on peritoneal dialysis vs hemodialysis in Colombia. Kidney Int Suppl: S165–172.
    1. Carrero JJ, de Mutsert R, Axelsson J, Dekkers OM, Jager KJ, et al. (2011) Sex differences in the impact of diabetes on mortality in chronic dialysis patients. Nephrol Dial Transplant 26: 270–276.
    1. US Renal Data System (2011) USRDS 2011 Annual Data Report: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
    1. Johnson DW, McDonald S, Excell L, Livingston B, Shtangey V (2010) ANZDATA Registry Report 2010.
    1. Johnson DW, Dent H, Hawley CM, McDonald SP, Rosman JB, et al. (2009) Associations of dialysis modality and infectious mortality in incident dialysis patients in Australia and New Zealand. Am J Kidney Dis 53: 290–297.
    1. Morduchowicz G, Winkler J, Derazne E, Van Dyk DJ, Wittenberg C, et al. (1992) Causes of death in patients with end-stage renal disease treated by dialysis in a center in Israel. Isr J Med Sci 28: 776–779.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe