Abstract
The number of dialysis patients continues to grow. In many parts of the world, peritoneal dialysis (PD) is a less expensive form of treatment. However, it has been questioned whether patients treated with PD can have as good a long-term outcome as that achieved with hemodialysis (HD). This skepticism has fueled ongoing comparisons of outcomes of patients treated with in-center HD and PD using data from national registries or prospective cohort studies. There are major challenges in comparing outcomes with two therapies when the treatment assignment is nonrandom. Furthermore, many of the intermodality comparisons include patients who started dialysis therapy in the 1990s. In many parts of the world, improvements in PD outcome have outpaced those seen with in-center HD. It is not surprising, then, that virtually all the recent observational studies from different parts of the world consistently show that long-term survival of HD and PD patients is remarkably similar. These studies support the case for a greater use of PD for the treatment of end-stage renal disease. This, in turn, could allow more patients to be treated for any given budgetary allocation to long-term dialysis.
Highlights
N in China – a pilot study has been successfully completed and the clinical trial is anticipated to begin enrollment in 2011 (ClinicalTrials.gov identifier: NCT00510549)
It has been appreciated that the relative risk of death for peritoneal dialysis (PD) patients varies over their time on dialysis 13, 14
Studies suggest that most patients starting dialysis in United States are often unaware of alternatives to in-center HD, and a randomized controlled trial indicates that comprehensive modality education increases selection of self-care dialysis[28, 29]
Summary
Contemporary studies suggest that the effect of dialysis modality on patient survival is rather small, if any. It is important to note that the improvement in PD outcomes and the consequent similarity in long-term outcomes of patients treated with PD and HD has been reported from countries with a wide range of PD uptake – from as low as 6-7% in the United States to almost 50% in Colombia. These studies support the case for greater use of PD in the treatment of end-stage renal disease – this, in turn, could allow more patients to be treated for any given budgetary allocation to long-term dialysis
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