We conclude that dialysis patients have a lower quality of life than RTx patients, but this difference can partly be explained by differences in age and prevalence of diabetes.

RTx patients tended to have a higher utility than dialysis patients. Among HD and PD patients, there were no statistically significant differences in utility.

Considerable geographic variation exists in the relative use of hemodialysis (HD) vs peritoneal dialysis (PD). Studies comparing survival between these modalities have yielded conflicting results. Our aim was to compare the survival of Dutch HD and PD patients. We developed Cox regression models using 16 643 patients from the Dutch End-Stage Renal Disease Registry (RENINE) adjusting for age, gender, primary renal disease, center of dialysis, year of start of renal replacement therapy, and included several interaction terms. We assumed definite treatment assignment at day 91 and performed an intention-to-treat analysis, censoring for transplantation. To account for time dependency, we stratified the analysis into three time periods, >3-6, >6-15, and >15 months. For the first period, the mortality hazard ratio (HR) of PD compared with HD patients was 0.26 (95% confidence interval (CI) 0.17-0.41) for 40-year-old non-diabetics, which increased with age and presence of diabetes to 0.95 (95% CI 0.64-1.39) for 70-year-old patients with diabetes as primary renal disease. The HRs of the second period were generally higher. After 15 months, the HR was 0.86 (95% CI 0.74-1.00) for 40-year-old non-diabetics and 1.42 (95% CI 1.23-1.65) for 70-year-old patients with diabetes as primary renal disease. We conclude that the survival advantage for Dutch PD compared with HD patients decreases over time, with age and in the presence of diabetes as primary disease.

We suggest that CDUS be used as initial imaging modality of dysfunctional shunts, but complete access should be depicted at DSA and angioplasty to detect all significant stenoses eligible for intervention. CE-MRA should be considered only if DSA is inconclusive.

Avoidance of dialysis-related morbidity, improvement in quality of life, and reduction of costs have been mentioned as advantages of preemptive kidney transplantation. However, this therapeutic option is underutilized. Previous studies assessing the patient survival benefit of preemptive kidney transplantation compared it with postdialysis kidney transplantation. These studies may have been subjected to lead-time bias. When comparing patient survival of preemptive kidney transplant patients with waitlisted dialysis patients, there is a clear patient survival advantage in favor of preemptive kidney transplantation. This benefit justifies encouragement of preemptive kidney transplantation.