Effects of dialysis modality on mortality in patients with end‐stage renal disease: A cohort study

Abstract

Methods Using a retrospective 15‐year cohort, stratified by age, this study aimed to analyze the effect of dialysis modality on mortality of ESRD patients in a city of China. Study data were from the medical insurance information system of Kunshan, Jiangsu Province of China, and 1484 patients with ESRD, enrolled from 1 January 2005 to 31 December 2019 were included in this study. The primary outcome event was all‐cause mortality, which was calculated in months. Dialysis modalities included hemodialysis (HD) and peritoneal dialysis (PD). Survival analysis and competing‐risk regression model were performed in this study. Results HD costs significantly higher medical expense than the PD treatment regimen. The mean survival time was 121.28 (SE = 3.020) months for HD patients, while that was 94.68 (SE = 3.534) months for the PD. Ten‐year survival rates of the young, middle‐aged, and elderly were 0.82, 0.56, and 0.26, respectively. For the young (SHR = 0.869, 95% CI: 0.525–1.436) and middle‐aged (SHR = 0.715, 95% CI: 0.484–1.057) ESRD patients, different dialysis modalities exhibited no statistical significance on the survival, but for the elderly, HD had a lower risk of mortality than PD (SHR = 0.747, 95% CI: 0.581–0.961). Conclusion Survival of the young and middle‐aged ESRD patients was superior to that of the elderly. Considering both survival time and direct medical costs, we recommend that PD could be a better choice for young and middle‐aged ESRD patients, while HD may be suitable for older patients.