Abstract
There has been paucity of data regarding the secular trend of adverse outcomes in peritoneal dialysis (PD) as compared with hemodialysis (HD) in Korea. 96,596 patients who started dialysis between 2004–2015 in Korea were identified using the National Health Insurance Service database. The adjusted hazard ratio (HR) (95% confidence interval, CI) of PD over HD for mortality was 1.31 (1.27–1.36; P < 0.001) in the period of 2004–2007 and 1.21 (1.16–1.27; P < 0.001) in the period of 2008–2011. However, the hazard of PD over HD for mortality turned out to be insignificant in the period of 2012–2015. Similar trend was noted for nonfatal cardiovascular events (CVEs). In subgroup analysis, the hazard of PD over HD for mortality was evident, regardless of the status of age, diabetes, and comorbidity burden in 2004–2011. In 2012–2015, however, the hazard of PD over HD for mortality was insignificant when follow up was censored at one year, which became significant when follow up follow up was censored at three or five year. In conclusion, the mortality of PD over HD in Korea has been significantly improved, a finding that was paralleled by the improved nonfatal CVEs.
Highlights
In Korea, the overall number of patients with end-stage renal disease (ESRD) reached 80,674 at the end of 20141
The proportion of medical aid was higher in HD patients than in peritoneal dialysis (PD) patients, while income status was lower in HD patients than in PD patients, but this difference decreased in magnitude as the study period increased
The rate of atrial fibrillation was similar in PD patients throughout the study period, it was increased in HD patients with the progression of the study period
Summary
In Korea, the overall number of patients with end-stage renal disease (ESRD) reached 80,674 at the end of 20141. Only 9.2% were on peritoneal dialysis (PD), which was attributed to the net decrease in the prevalence of PD patients since the mid-2000s1. The decrease of PD patients is not a unique feature of Korea. Patients with PD may have more favorable transplantation outcomes than those with HD9. Despite these advantages, efforts to revive PD have fallen into insignificance because of the lack of confidence in survival benefits of PD over HD. Our group recently reported that the survival rate associated with PD was inferior to that with HD among Korean ESRD patients who initiated dialysis between 2005 and 2008, using data from the national insurance database[10].
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