Comparative mortality of hemodialysis and peritoneal dialysis in Canada
- 1 April 2000
- journal article
- research article
- Published by Elsevier BV in Kidney International
- Vol. 57 (4), 1720-1726
- https://doi.org/10.1046/j.1523-1755.2000.00017.x
Abstract
Comparisons of mortality rates in patients on hemodialysis versus those on peritoneal dialysis have been inconsistent. We hypothesized that comorbidity has an important effect on differential survival in these two groups of patients. Eight hundred twenty-two consecutive patients at 11 Canadian institutions with irreversible renal failure had an extensive assessment of comorbid illness collected prospectively, immediately prior to starting dialysis therapy. The cohort was assembled between March 1993 and November 1994; vital status was ascertained as of January 1, 1998. The mean follow-up was 24 months. Thirty-four percent of patients at baseline, 50% at three months, and 51% at six months used peritoneal dialysis. Values for a previously validated comorbidity score were higher for patients on hemodialysis at baseline (4.0 vs. 3.1, P < 0.001), three months (3.7 vs. 3.2, P = 0.001), and six months (3.6 vs. 3.2, P = 0.005). The overall mortality was 41%. The unadjusted peritoneal dialysis/hemodialysis mortality hazard ratios were 0.65 (95% CI, 0. 51 to 0.83, P = 0.0005), 0.84 (95% CI, 0.66 to 1.06, P = NS), and 0. 83 (95% CI, 0.64 to 1.08, P = NS) based on the modality of dialysis in use at baseline, three months, and six months, respectively. When adjusted for age, sex, diabetes, cardiac failure, myocardial infarction, peripheral vascular disease, malignancy, and acuity of renal failure, the corresponding hazard ratios were 0.79 (95% CI, 0. 62 to 1.01, P = NS), 1.00 (95% CI, 0.78 to 1.28, P = NS), and 0.95 (95% CI, 0.73 to 1.24, P = NS). Adjustment for a previously validated comorbidity score resulted in hazard ratios of 0.74 (95% CI, 0.58 to 0.94, P = 0.01), 0.94 (95% CI, 0.74 to 1.19, P = NS), and 0.88 (95% CI, 0.68 to 1.13, P = NS) at baseline, three months, and six months. There was no survival advantage for either modality in any of the major subgroups defined by age, sex, or diabetic status. The apparent survival advantage of peritoneal dialysis in Canada is due to lower comorbidity and a lower burden of acute onset end-stage renal disease at the inception of dialysis therapy. Hemodialysis and peritoneal dialysis, as practiced in Canada in the 1990s, are associated with similar overall survival rates.Keywords
This publication has 18 references indexed in Scilit:
- Mortality in End-Stage Renal DiseaseJournal of the American Society of Nephrology, 1999
- Hemodialysis versus peritoneal dialysis: A comparison of adjusted mortality ratesAmerican Journal of Kidney Diseases, 1997
- Demography and survival of patients receiving treatment for chronic renal failure in Australia and New Zealand: report on dialysis and renal transplantation treatment from the Australia and New Zealand dialysis and transplant registryAmerican Journal of Kidney Diseases, 1995
- Continuous ambulatory peritoneal dialysis and hemodialysis: Comparison of patient mortality with adjustment for comorbid conditionsKidney International, 1994
- A Multicenter, Selection-Adjusted Comparison of Patient and Technique Survivals on CAPD and HemodialysisPeritoneal Dialysis International, 1991
- Comparison of Survival in Continuous Ambulatory Peritoneal Dialysis and Hospital Haemodialysis: A Multicentric StudyNephrology Dialysis Transplantation, 1991
- A Comparison of Survival Among Dialytic Therapies of Choice: In-Center Hemodialysis Versus Continuous Ambulatory Peritoneal Dialysis at HomeAmerican Journal of Kidney Diseases, 1990
- OUTCOME IN PATIENTS ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS AND HAEMODIALYSIS: 4-YEAR ANALYSIS OF A PROSPECTIVE MULTICENTRE STUDYThe Lancet, 1987
- SELECTION-ADJUSTED COMPARISON OF LIFE-EXPECTANCY OF PATIENTS ON CONTINUOUS AMBULATORY PERITONEAL DIALYSIS, HAEMODIALYSIS, AND RENAL TRANSPLANTATIONThe Lancet, 1987
- A Comparative Study of Continuous Ambulatory Peritoneal Dialysis and Center HemodialysisArchives of Internal Medicine, 1986