Hemodialysis vs Peritoneal Dialysis: Comparison of Net Survival in Incident Patients on Chronic Dialysis in Colombia

Abstract

Background: In the area of nephrology, the practical application of relative survival methodologies can provide information regarding the impact of outcomes for patients with kidney failure on dialysis compared with what would be expected in the absence of this condition. Objective: Compare the net survival of hemodialysis (HD) and peritoneal dialysis (PD) patients in a cohort of incident patients on chronic dialysis in Colombia, according to the dialysis therapy modality. Design: Observational, analytic, historical cohort. Setting: Renal Therapy Services (RTS) clinic network across Colombia. Patients: Patients over 18 years old with chronic kidney disease, incidents in dialytic therapy, which reached day 90 of therapy. Recruitment took place from January 1, 2008, to December 31, 2013, with a follow-up until December 31, 2018. The final cohort for analysis corresponds to a total of 12 508 patients, of which 5330 patients (42.6%) began HD and 7178 patients (57.4%) began PD. Measurements: Demographic, socioeconomic, and clinical variables were measured. Methods: Analyses were conducted according to the treatment assigned (PD or HD) at the time of the inception of the cohort and another approach of analysis was done with a subsample of those patients who never changed the initial modality. To calculate expected survival, life tables were constructed for Colombia for the years 2006 to 2018. Net survival estimates were made using the Pohar Perme estimator. The comparison of the net survival curves was done using the method developed by Pavlič and Perme, the log-rank type. Results: Net survival at 5 years compared with the general population was estimated at 0.53 (95% confidence interval 0.52-0.54) in the dialysis cohort. In intention-to-treat analyses of 7178 patients on PD and 5330 patients on HD, by global and Pohar-Perme methods, survival (expressed as a ratio of survival in patients on dialysis to survival in an age-, sex- and geographic-matched general Colombian population) was higher in patients on HD than in those on PD. In year 1, net survival by Pavlov-Perme on PD was 0.79 (95% confidence intervals [CI] 0.78 - 0.80) and on HD 0.85 (95% CI 0.84 - 0.86); in year 5, 0.36 (95% CI 0.34 – 0.38) and 0.57 (95% CI 0.55 – 0.59) for PD and HD respectively. Limitation: There may be imbalances among the populations analyzed (HD vs PD), in which one or more variables other than the type of therapy may influence the survival of the patients. In Colombia there are marginal levels of underreporting of demographic data in some subpopulations that may affect life-tables construction. Conclusion: An important difference was observed in terms of survival between the dialysis population and the population of reference without dialysis. Statistically significant differences were found in net survival between HD and PD, net survival was higher in patients on HD than in those on PD.

Long-term mortality in patients with end-stage renal disease undergoing hemodialysis and peritoneal dialysis: a propensity score matching retrospective study

“…concluded that the important difference between HD and PD was that the survival rate of patients on HD was higher than that of patients on PD, which was significant after 5 years of follow-up in 12,508 patients undergoing dialysis. 9 Similarly, Mukhopadhyay et al. concluded that the survival rate of patients on HD was higher than that of patients on PD after 5 years of follow-up in 130,324 patients undergoing dialysis.…”

Factores que influyen en la supervivencia de pacientes con diálisis en El Salvador

“…Un estudio realizado en Colombia con una cohorte de 12 508 pacientes mayores de 18 años, mostró una supervivencia similar a la encontrada en este estudio, con una tasa del 53 % a los cinco años de tratamiento 13 , otro estudio realizado en Indonesia, aunque con una cohorte más pequeña que incluía únicamente pacientes en diálisis peritoneal, encontró una supervivencia a los cinco años del 52 % 14 . Debido a la baja supervivencia en pacientes en diálisis, la detección de la ERC en etapas tempranas, y las acciones para retrasar la progresión de esta se consideran la mejor medida para alargar la vida de los pacientes renales 2 .…”

“…Los estudios que comparan las modalidades de tratamiento no sugieren hallazgos consistentes, mientras que en algunos se ha encontrado una mayor supervivencia en pa-cientes sometidos a hemodiálisis, como el estudio de cohorte colombiano mencionado anteriormente 13 ; en otras investigaciones no se ha encontrado diferencia significativa entre las modalidades de tratamiento 15,16 ; y, otros sugieren que las diferencias pueden estar relacionadas con una mayor carga de comorbilidades en un grupo u otro 15,17 . Por este motivo algunas guías clínicas recomiendan dejar la modalidad del tratamiento a elección del paciente, de acuerdo a sus necesidades y situación clínica 1,2 .…”

Dialysis Outcomes in a Middle-Income Country: An Updated Comparison of Patient Mortality between Hemodialysis and Peritoneal Dialysis

“…BRCS offers a person-centered approach with pre-dialysis education regarding dialysis modalities and shared decision-making between the patient, family, treating nephrologist, and clinical team. The relative balance between HD and PD, with 42.6% of the patients beginning on HD and 57.4% on PD [22], affords an excellent opportunity to compare survival outcomes between these 2 types of dialysis therapies.…”

“…In the mid-2000s, our group published a study showing comparable survival between HD and PD in Colombia [23]. A more recent study reported higher relative survival for HD patients, although this analysis was a crude comparison [22]. The objective of this study was to compare the mortality of patients on the 2 dialysis modalities using propensity score matching (PSM) and to identify the variables associated with mortality.…”