Hemodialysis versus Peritoneal Dialysis: A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease

Abstract

BackgroundStudies comparing patient survival of hemodialysis (HD) and peritoneal dialysis (PD) have yielded conflicting results and no such study was from South-East Asia. This study aimed to compare the survival outcomes of patients with end-stage renal disease (ESRD) who started dialysis with HD and PD in Singapore.MethodsSurvival data for a maximum of 5 years from a single-center cohort of 871 ESRD patients starting dialysis with HD (n = 641) or PD (n = 230) from 2005–2010 was analyzed using the flexible Royston-Parmar (RP) model. The model was also applied to a subsample of 225 propensity-score-matched patient pairs and subgroups defined by age, diabetes mellitus, and cardiovascular disease.ResultsAfter adjusting for the effect of socio-demographic and clinical characteristics, the risk of death was higher in patients initiating dialysis with PD than those initiating dialysis with HD (hazard ratio [HR]: 2.08; 95% confidence interval [CI]: 1.67–2.59; p<0.001), although there was no significant difference in mortality between the two modalities in the first 12 months of treatment. Consistently, in the matched subsample, patients starting PD had a higher risk of death than those starting HD (HR: 1.73, 95% CI: 1.30–2.28, p<0.001). Subgroup analysis showed that PD may be similar to or better than HD in survival outcomes among young patients (≤65 years old) without diabetes or cardiovascular disease.ConclusionESRD patients who initiated dialysis with HD experienced better survival outcomes than those who initiated dialysis with PD in Singapore, although survival outcomes may not differ between the two dialysis modalities in young and healthier patients. These findings are potentially confounded by selection bias, as patients were not randomized to the two dialysis modalities in this cohort study.

Cost‐effectiveness of haemodialysis and peritoneal dialysis for patients with end‐stage renal disease in Singapore

“…The mortality rates of dialysis patients were obtained from a study investigating survival outcomes of 871 incident ESRD patients in Singapore . Due to the lack of survival data for CAPD and APD patients, we assumed that the mortality rates were the same for both PD modalities.…”

Cytokines, adipocytokines and inflammatory markers in patients on continuous ambulatory peritoneal dialysis and hemodialysis

“…Reports indicating that they have similar effects on survival were also available. 13 In our study, We aimed to evaluate cytokines, adipocytokines and inflammatory markers in patients with CRF undergoing CAPD and HD.…”

More Use of Peritoneal Dialysis Gives Significant Savings: A Systematic Review and Health Economic Decision Model

“…From 3 years and more, HD reported a survival advantage over PD [44, 45, 47, 48]. In our SR, we included studies with a follow-up time up to 5 years.…”

“…The patients in the included studies in our SR did not differ significantly in comorbidity, including diabetes, and were similar in age, at baseline. It has been shown that for patients above 65 with diabetes or cardiovascular disease, there may be a survival advantage in the HD group [47]. However, an SR from 2014 [49] showed that there is inconsistent evidence to which modality is the best initial treatment for diabetics patients with ESRD.…”