Comparison of survival outcomes in haemodialysis versus immediate-start peritoneal dialysis: A propensity-matched study.

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Recent reports suggest that immediate-start peritoneal dialysis (ISPD) initiated immediately after catheter insertion demonstrates better long-term outcomes. However, the survival rate of ISPD versus haemodialysis (HD) remains uncertain. This study aimed to compare survival rates between ISPD and HD using a matched-pair cohort. We retrospectively reviewed the medical records of 911 patients with end-stage kidney disease (ESKD) who received HD or peritoneal dialysis at our centre between August 2005 and September 2023. After 1:1 propensity score matching between ISPD and HD patients, we calculated survival rates using Kaplan-Meier analysis and identified the influencing factors with multivariate Cox regression. In this cohort of 911 patients, ISPD and HD groups included 162 and 676 patients respectively. After 1:1 propensity matching 140 patients on ISPD were matched with 140 patients on HD. The 1-, 2-, 3-, 4-, and 5-year survival rates were 98.5%, 93.6%, 92.5%, 91.1%, and 91.1% for ISPD, and 96.3%, 93.0%, 90.4%, 87.2%, and 83.3% for HD groups (log-rank p = 0.17). The survival rates were comparable between the groups. However, in the non-diabetic population, patients on ISPD showed significantly higher survival rates than those on HD (log-rank p = .03). Diabetes was an independent risk factor for mortality in the ISPD group according to multivariate Cox regression. Long-term survival rates were comparable between ISPD and HD groups. The survival benefit was more pronounced in the non-diabetic population. These results suggest that ISPD may be a better renal replacement therapy option than HD, particularly for the non-diabetic ESKD population in terms of patient survival.