The benefit of early survival on PD versus HD—Why this is (still) very important
Open Access
- 18 February 2020
- journal article
- review article
- Published by SAGE Publications in Peritoneal Dialysis International
- Vol. 40 (4), 405-418
- https://doi.org/10.1177/0896860819895177
Abstract
There are a number of misconceptions around the identified early survival benefit of peritoneal dialysis (PD) relative to hemodialysis (HD), including that such benefits “even out in the end” since the relative risk of death over time eventually encompasses 1.0 (or even an estimate that is unfavorable to PD); that the early benefit is, in fact, most likely due to unmeasured confounding; and such benefits are only due to the influence of central venous catheters and “crash starters” in the HD group. In fact, the early survival benefit results in a substantial gain of patient life years in PD cohorts relative to HD ones, even if it the benefit appears to “even out in the end,” is relatively insensitive to unmeasured confounding, and persists even when the effects of central venous catheters are accounted for. In this review, the calculations and arguments are made to support these tenets. Survival on dialysis is still one of the most important considerations for all stakeholders in the end-stage kidney disease community, including patients who rank it among their top priorities. Shared decision-making is a fundamental patient right and requires both balanced information and an iterative mechanism for a consensual decision based on shared understanding and purpose. A cornerstone of this process should be an explicit discussion of the early survival benefit of PD relative to HD.Keywords
This publication has 117 references indexed in Scilit:
- Effect of Cinacalcet on Cardiovascular Disease in Patients Undergoing DialysisThe New England Journal of Medicine, 2012
- China collaborative study on dialysis: a multi-centers cohort study on cardiovascular diseases in patients on maintenance dialysisBMC Nephrology, 2012
- Effects of starting hemodialysis with an arteriovenous fistula or central venous catheter compared with peritoneal dialysis: a retrospective cohort studyBMC Nephrology, 2012
- Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in CanadaNephrology Dialysis Transplantation, 2012
- Home Hemodialysis and Mortality Risk in Australian and New Zealand PopulationsAmerican Journal of Kidney Diseases, 2011
- Bias Formulas for Sensitivity Analysis of Unmeasured Confounding for General Outcomes, Treatments, and ConfoundersEpidemiology, 2011
- The Hazards of Hazard RatiosEpidemiology, 2010
- Bias Formulas for External Adjustment and Sensitivity Analysis of Unmeasured ConfoundersAnnals of Epidemiology, 2008
- Type of vascular access and mortality in U.S. hemodialysis patientsKidney International, 2001
- Meta-analysis in clinical trialsControlled Clinical Trials, 1986