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Abstract
It is hypothesized, but not proven, that peritoneal dialysis might be the optimal
treatment for end-stage renal disease (ESRD) patients with established congestive
heart failure (CHF) through better volume regulation compared with hemodialysis.
National incidence data on 107,922 new ESRD patients from the Center for Medicare
and Medicaid Services (CMS) Medical Evidence Form were used to test the hypothesis
that peritoneal dialysis was superior to hemodialysis in prolonging survival of patients
with CHF. Nonproportional Cox regression models evaluated the relative hazard of death
for patients with and without CHF by dialysis modality using primarily the intent-to-treat
but also the as-treated approach. Diabetics and nondiabetics were analyzed separately.
The overall prevalence of CHF was 33% at ESRD initiation. There were 27,149 deaths
(25.2%), 5423 transplants (5%), and 3753 (3.5%) patients lost to follow-up over 2
years. Adjusted mortality risks were significantly higher for patients with CHF treated
with peritoneal dialysis than hemodialysis [diabetics, relative risk (RR) = 1.30,
95% confidence interval (CI) 1.20 to 1.41; nondiabetics, RR = 1.24, 95% CI 1.14 to
1.35]. Among patients without CHF, adjusted mortality risk were higher only for diabetic
patients treated with peritoneal dialysis compared with hemodialysis (RR = 1.11, 95%
CI 1.02 to 1.21) while nondiabetics had similar survival on peritoneal dialysis or
hemodialysis (RR = 0.97, 95% CI 0.91 to 1.04).
New ESRD patients with a clinical history of CHF experienced poorer survival when
treated with peritoneal dialysis compared with hemodialysis. These data suggest that
peritoneal dialysis may not be the optimal choice for new ESRD patients with CHF perhaps
through impaired volume regulation and worsening cardiomyopathy.