Comparative mortality of hemodialysis and peritoneal dialysis in Canada

Murphy, Sean; Foley, Robert N.; Barrett, Brendan; Kent, Gloria M.; Morgan, J.G.; Barré, Paul E.; Campbell, Patricia; Fine, Adrian; Goldstein, Marc B.; Handa, Satoshi; Jindal, Kailash; Levin, Adeera; Mandin, Henry; Muirhead, Norman; Richardson, Robert; Parfrey, Patrick S.

doi:10.1046/j.1523-1755.2000.00017.x

Cited by 140 publications

(105 citation statements)

References 18 publications

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“…We confirm earlier studies that found excess mortality among older patients, especially those with diabetes on PD (19,20). Our findings are based on the experience of a large and typical cohort of incident ESRD patients aged Ͼ65 in a large eastern state of the United States rather than of a single center with above-average experience with PD (2,15,22), or from populations with higher overall utilization of PD relative to HD than is seen in the United States that may not be representative of the way renal health care is delivered in this country (4,6,11,17,21). If replicated in other studies, these results may be relevant to the decision of patients nearing ESRD and their physicians in making decisions about which treatment to choose for long-term RRT.…”

Section: Discussionmentioning

confidence: 99%

“…(1-22) These studies vary enormously with regard to population selection criteria, sample size, statistical methodology, definition of treatment, and availability of information on important potential confounders. The various results are conflicting: some studies have found a survival benefit for PD patients (12,16,18,20), others for those on HD (10,11,13), and still others have found mortality not to differ (2)(3)(4)(5)(6)(7)(8)14,15,19,21,22).Many of these previous studies, and all studies on US populations after 1983 have not adequately addressed a key methodologic issue: assessments that start at 4 or 6 mo after onset of RRT are likely to discard relevant events that occur between the first dialysis treatment and the chosen starting point of such studies, particularly modality switches and deaths. This omission can result in biased estimates of effect.…”

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confidence: 99%

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confidence: 99%

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Comparing Mortality of Elderly Patients on Hemodialysis versus Peritoneal Dialysis

Winkelmayer¹,

Glynn²,

Mittleman³

et al. 2002

Journal of the American Society of Nephrology

142

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Abstract. The objective of this study was to evaluate differences in mortality over the first year of renal replacement therapy (RRT) between elderly patients starting treatment on hemodialysis (HD) versus peritoneal dialysis (PD). For the period of 1991 to mid-1996, this study defined an inception cohort of all patients aged Ͼ65 yr with new-onset chronic RRT who were New Jersey Medicare and/or Medicaid beneficiaries in the year before RRT and who had been diagnosed with renal disease more than 1 yr before RRT. Propensity scores were calculated for first treatment assignment from a large number of baseline covariates. Mortality was then compared among patients initially assigned to HD versus PD using multivariate 90-d interval Cox models controlled for propensity scores and center stratification. Peritoneal dialysis starters had a 16% higher rate of death during the first 90 d of RRT compared with HD patients (hazard ratio [HR], 1.16; 95% confidence interval [CI], 0.96 to 1.42)]. Mortality did not differ between day 91 and 180 (HR, 1.03; 95% CI, 0.71 to 1.51). Thereafter, PD starters again died at a higher rate (HR, 1.45; 95% CI, 1.07 to 1.98). These findings were more pronounced among patients with diabetes. Sensitivity analyses using more stringent criteria to ensure that first treatment choice reflected long-term treatment choice confirmed the presence of an association between PD and mortality. In conclusion, compared with HD, peritoneal dialysis appears to be associated with higher mortality among older patients, particularly among those with diabetes, even after controlling for a large number of risk factors for mortality, propensity scores to control for nonrandom treatment assignment, and center stratification.Various studies have sought to answer the question of whether or not survival on peritoneal dialysis (PD) and hemodialysis (HD) differed. (1-22) These studies vary enormously with regard to population selection criteria, sample size, statistical methodology, definition of treatment, and availability of information on important potential confounders. The various results are conflicting: some studies have found a survival benefit for PD patients (12,16,18,20), others for those on HD (10,11,13), and still others have found mortality not to differ (2)(3)(4)(5)(6)(7)(8)14,15,19,21,22).Many of these previous studies, and all studies on US populations after 1983 have not adequately addressed a key methodologic issue: assessments that start at 4 or 6 mo after onset of RRT are likely to discard relevant events that occur between the first dialysis treatment and the chosen starting point of such studies, particularly modality switches and deaths. This omission can result in biased estimates of effect. Another important potential source of bias that frequently remained unaccounted for is uncontrolled center effects (23). Furthermore, potentially useful techniques developed to enhance control for nonrandom treatment assignment, such as propensity scores (PS) or g-estimation (24,25), have not been used in compa...

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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confidence: 99%

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Comparing Mortality of Elderly Patients on Hemodialysis versus Peritoneal Dialysis

Winkelmayer¹,

Glynn²,

Mittleman³

et al. 2002

Journal of the American Society of Nephrology

142

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“…Five years survival rate for HD patients in Northern part of Iran was 23%, while in southern region of Iran was 46.8% (9,10). Various factors such as albumin and hemoglobin levels, adequacy of dialysis, dialysis duration, method of RRT, body mass index (BMI), etiology of kidney failure, comorbid diseases (i.e., diabetes mellitus, cardiovascular disease), and infection rates adversely affect the survival rates of HD patients (11)(12)(13)(14)(15)(16)(17). Among all the aforementioned factors, cardiovascular disease (CVD) is considered as a leading cause of morbidity and mortality among HD patients (18,19).…”

Section: Introductionmentioning

confidence: 99%

Predictors of long-term survival of hemodialysis patients in Hamadan province, west of Iran

Khazaei¹,

Yaseri²,

Sheikh³

et al. 2017

J Nephropathol

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Background: Hemodialysis (HD) represents the main way of renal replacement therapy (RRT) for end-stage renal disease (ESRD) patients in Iran. Few studies have investigated the survival of HD patients in Iran.Objectives: This study conducted to reach better understanding predictors of survival for HD patients. Patients and Methods: This is a retrospective cohort study conducted in 1142 HD patients in Hamadan province during 11 years from 2007 to 2017. The checklist used to gather information was comprised of patient's demographic and clinical information. The analysis was carried out using Laplace regression and Cox regression model. Results:The most prevalent causes of ESRD were reported to be high blood pressure (BP) (28.9%) and diabetes (24.34%). The probability of survival at the end of 1st, 5th, and 10th year was 0.81, 0.4 and 0.13, respectively. Results of multivariate Cox regression showed that being rural dweller, low albumin, ferritin and hemoglobin level and having positive CRP at diagnosis have a negative significant impact on survival of HD patients (P < 0.05). Conclusions: Being rural dweller, low albumin and hemoglobin level and having positive CRP at diagnosis amongst other factors were possible factors affecting the survival of HD patients in this study. Considering the low survival probability of these patients, efforts should be made to real-time diagnosis of the cause of renal diseases.

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“…By design, we studied hemodialysis patients without overt cardiac disease, and the generalizability of our findings to other populations with chronic kidney disease is not certain. Our results are applicable to approximately 50% of the dialysis population (18). The high dropout rate was anticipated because patients such as those in our study are usually referred for and then wait for renal transplantation.…”

Section: Discussionmentioning

confidence: 84%

Erythropoietin Therapy, Hemoglobin Targets, and Quality of Life in Healthy Hemodialysis Patients

Foley¹,

Curtis²,

Parfrey³

2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: The effects of different hemoglobin targets when using erythropoiesis-stimulating agents on quality of life are somewhat controversial, and predictors of change in quality of life in endstage renal disease have not been well characterized.Design, setting, participants, & measurements: Five hundred ninety-six incident hemodialysis patients without symptomatic cardiac disease were randomly assigned to hemoglobin targets of 9.5 to 11.5 g/dl or 13.5 to 14.5 g/dl for 96 weeks, using epoetin_alfa as primary therapy. Patients and attending physicians were masked to treatment assignment. Quality of life, a secondary outcome, was prospectively recorded using the Kidney Disease Quality of Life (KDQoL) questionnaire at weeks 0, 24, 36, 48, 60, 72, 84, and 96, with prespecified outcomes being fatigue and quality of social interaction.Results: The mean age and prior duration of dialysis therapy of the study population were 50.8 and 0.8 yr. Mortality was low, reflecting the relatively healthy group enrolled. Of 20 domains within the KDQoL only the prespecified domain of fatigue showed significant change over time between the two groups. Improvement in fatigue scores in the high-target group ranged from 3.2 to 7.9 over time (P ‫؍‬ 0.007) compared with change in the low-target group. Higher body mass index and lower erythropoietin dose at baseline were independent predictors of improvement in multiple KDQoL domains.Conclusions: In relatively healthy hemodialysis patients, normal hemoglobin targets may have beneficial effects on fatigue. Improvement in multiple domains of quality of life is associated with higher body mass index and lower erythropoietin requirements.

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Comparative mortality of hemodialysis and peritoneal dialysis in Canada

Cited by 140 publications

References 18 publications

Comparing Mortality of Elderly Patients on Hemodialysis versus Peritoneal Dialysis

Comparing Mortality of Elderly Patients on Hemodialysis versus Peritoneal Dialysis

Predictors of long-term survival of hemodialysis patients in Hamadan province, west of Iran

Erythropoietin Therapy, Hemoglobin Targets, and Quality of Life in Healthy Hemodialysis Patients

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