Abstract
BackgroundWhether the choice of dialysis modality in patients with end stage renal disease may impact mortality is undecided. No randomized controlled trial has properly addressed this issue. Propensity-matched observational studies could give important insight into the independent effect of peritoneal (PD) opposed to haemodialysis (HD) on all-cause and cardiovascular mortality.MethodsTo correct for case-mix differences between patients treated with PD and HD, propensity-matched analyses were utilized in all patients who initiated dialysis as first renal replacement therapy in Norway in the period 2005–2012. PD patients were matched in a 1:1 fashion with HD patients, creating 692 pairs of patients with comparable baseline variables. As-treated and intention-to treat analyses were undertaken to assess cardiovascular and all-cause mortality. Interaction analyses were used to assess differences in the relationship between initial dialysis modality and mortality, between strata of age, gender and prevalent diabetes mellitus.ResultsIn the as-treated analyses, initial dialysis modality did not impact 2-year (PD vs. HD: HR 0.87, 95 % CI 0.67–1.12) or 5-year all-cause mortality (HR 0.95, 95 % CI 0.77–1.17). In patients younger than 65 years, PD was superior compared to HD with regard to both 2-year (HR 0.39, 95 % CI 0.19–0.81), and 5-year all-cause mortality (HR 0.49, 95 % CI 0.27–0.89). Cardiovascular mortality was also lower in the younger patients treated with PD (5-year HR 0.38, 95 % CI 0.15–0.96). PD was not associated with impaired prognosis in any of the prespecified subgroups compared to HD. The results were similar in the as-treated and intention-to-treat analyses.ConclusionSurvival in PD was not inferior to HD in any subgroup of patients even after five years of follow-up. In patients below 65 years, PD yielded superior survival rates compared to HD. Increased use of PD as initial dialysis modality in ESRD patients could be encouraged.
Highlights
Whether the choice of dialysis modality in patients with end stage renal disease may impact mortality is undecided
An aging population and increasing incidence of atherosclerotic disease, hypertension and diabetes have caused a substantial rise in patients in need of renal replacement therapy (RRT) in Norway similar to what has been observed in other countries [1, 2]
2-year all-cause mortality was more than halved in the younger Peritoneal dialysis (PD) patients compared to what was observed in HD patients, and the improved all-cause and cardiovascular survival persisted through five year of follow-up
Summary
Whether the choice of dialysis modality in patients with end stage renal disease may impact mortality is undecided. Propensity-matched observational studies could give important insight into the independent effect of peritoneal (PD) opposed to haemodialysis (HD) on all-cause and cardiovascular mortality. An aging population and increasing incidence of atherosclerotic disease, hypertension and diabetes have caused a substantial rise in patients in need of renal replacement therapy (RRT) in Norway similar to what has been observed in other countries [1, 2]. Peritoneal dialysis (PD) and haemodialysis (HD) are considered equivalent treatment options in end stage renal disease (ESRD). No randomized controlled trial has been performed to assess the independent effect of HD and PD on mortality, and this is unlikely to ever occur. Notwithstanding, a survival advantage for PD the first years after dialysis initiation has been reported in young patients without comorbidity, e.g
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