12
views
0
recommends
+1 Recommend
0 collections
    1
    shares
      • Record: found
      • Abstract: found
      • Article: found
      Is Open Access

      Peritoneal dialysis: update on patient survival

      review-article

      Read this article at

      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Due to ongoing limitations in the availability and timeliness of kidney transplantation, most patients with end-stage renal disease (ESRD) require some form of dialysis during their lifetime. Worldwide, ESRD patients most commonly receive hemodialysis (HD) or one of two forms of peritoneal dialysis (PD), continuous ambulatory PD (CAPD) or automated PD (APD). In this review, we analyze the data available from the last several decades on overall survival associated with HD as compared to PD as well as with CAPD compared to APD. Because of the inherent difficulty in randomly assigning patients to different dialysis modalities, the survival data available are virtually all observational and fraught with many confounding factors and limitations. However, over the last 10 – 15 years as overall survival of dialysis patients has steadily improved and statistical methods to analyze observational data have evolved, a pattern of virtual equivalence in survival among patients on HD vs. PD and on CAPD vs. APD has emerged. As such, impact upon lifestyle and upon quality of life likely should remain the predominant factors in guiding nephrologists and their patients in their choice of dialysis modality.

          Related collections

          Most cited references39

          • Record: found
          • Abstract: found
          • Article: not found

          Type of vascular access and mortality in U.S. hemodialysis patients.

          Vascular access (VA) complications account for 16 to 25% of hospital admissions. This study tested the hypothesis that the type of VA in use is correlated with overall mortality and cause-specific mortality. Data were analyzed from the U.S. Renal Data System Dialysis Morbidity and Mortality Study Wave 1, a random sample of 5507 patients, prevalent on hemodialysis as of December 31, 1993. The relative mortality risk during a two-year observation was analyzed by Cox-regression methods with adjustments for demographic and comorbid conditions. Using similar methods, cause-specific analyses also were performed for death caused by infection and cardiac causes. In diabetic mellitus (DM) patients with end-stage renal disease, the associated relative mortality risk was higher for those with arteriovenous graft (AVG; RR = 1.41, P < 0.003) and central venous catheter (CVC; RR = 1.54, P < 0.002) as compared with arteriovenous fistula (AVF). In non-DM patients, those with CVC had a higher associated mortality (RR = 1.70, P < 0.001), as did to a lesser degree those with AVG (RR = 1.08, P = 0.35) when compared with AVF. Cause-specific analyses found higher infection-related deaths for CVC (RR = 2.30, P < 0.06) and AVG (RR = 2.47, P < 0.02) compared with AVF in DM; in non-DM, risk was higher also for CVC (RR = 1.83, P < 0.04) and AVG (RR = 1.27, P < 0.33). In contrast to our hypothesis that AV shunting increases cardiac risk, deaths caused by cardiac causes were higher in CVC than AVF for both DM (RR = 1.47, P < 0.05) and non-DM (RR = 1.34, P < 0.05) patients. This case-mix adjusted analysis suggests that CVC and AVG are correlated with increased mortality risk when compared with AVF, both overall and by major causes of death.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Vascular access and all-cause mortality: a propensity score analysis.

            The native arteriovenous fistula (AVF) is the preferred vascular access because of its longevity and its lower rates of infection and intervention. Recent studies suggest that the AVF may offer a survival advantage. Because these data were derived from observational studies, they are prone to potential bias. The use of propensity scores offers an additional method to reduce bias resulting from nonrandomized treatment assignment. Adult (age 18 yr or more) patients who commenced hemodialysis in Australia and New Zealand on April 1, 1999, until March 31, 2002, were studied by using the Australian and New Zealand Dialysis and Transplant Association (ANZDATA) Registry. Cox regression was used to determine the effect of access type on total mortality. Propensity scores were calculated and used both as a controlling variable in the multivariable model and to construct matched cohorts. The catheter analysis was stratified by dialysis duration at entry to ANZDATA to satisfy the proportional-hazard assumption. There were 612 deaths in 3749 patients (median follow-up, 1.07 yr). After adjustment for confounding factors and propensity scores, catheter use was predictive of mortality. Patients with arteriovenous grafts (AVG) also had a significantly increased risk of death. Effect estimates were also consistent in the smaller propensity score-matched cohorts. Both AVG and catheter use in incident hemodialysis patients are associated with significant excess of total mortality. Reducing catheter use and increasing the proportion of patients commencing hemodialysis with a mature AVF remain important clinical objectives.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients.

              Contemporary comparisons of mortality in matched hemodialysis and peritoneal dialysis patients are lacking. We aimed to compare survival of incident hemodialysis and peritoneal dialysis patients by intention-to-treat analysis in a matched-pair cohort and in subsets defined by age, cardiovascular disease, and diabetes. We matched 6337 patient pairs from a retrospective cohort of 98,875 adults who initiated dialysis in 2003 in the United States. In the primary intention-to-treat analysis of survival from day 0, cumulative survival was higher for peritoneal dialysis patients than for hemodialysis patients (hazard ratio 0.92; 95% CI 0.86 to 1.00, P = 0.04). Cumulative survival probabilities for peritoneal dialysis versus hemodialysis were 85.8% versus 80.7% (P < 0.01), 71.1% versus 68.0% (P < 0.01), 58.1% versus 56.7% (P = 0.25), and 48.4% versus 47.3% (P = 0.50) at 12, 24, 36, and 48 months, respectively. Peritoneal dialysis was associated with improved survival compared with hemodialysis among subgroups with age <65 years, no cardiovascular disease, and no diabetes. In a sensitivity analysis of survival from 90 days after initiation, we did not detect a difference in survival between modalities overall (hazard ratio 1.05; 95% CI 0.96 to 1.16), but hemodialysis was associated with improved survival among subgroups with cardiovascular disease and diabetes. In conclusion, despite hazard ratio heterogeneity across patient subgroups and nonconstant hazard ratios during the follow-up period, the overall intention-to-treat mortality risk after dialysis initiation was 8% lower for peritoneal dialysis than for matched hemodialysis patients. These data suggest that increased use of peritoneal dialysis may benefit incident ESRD patients.
                Bookmark

                Author and article information

                Journal
                Clin Nephrol
                Clin. Nephrol
                Dustri
                Clinical Nephrology
                Dustri-Verlag Dr. Karl Feistle
                0301-0430
                January 2015
                27 October 2014
                : 83
                : 1
                : 1-10
                Affiliations
                Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA
                Author notes
                Correspondence to Isaac Teitelbaum, MD Division of Renal Diseases and Hypertension, University of Colorado, 12700 E 19th Ave, Aurora, CO 80045, USA Isaac.Teitelbaum@ 123456ucdenver.edu
                Article
                10.5414/CN108382
                5467157
                25345384
                6983f66e-4e2b-4f51-8eab-cd1cca14701f
                © Dustri-Verlag Dr. K. Feistle

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 28 May 2014
                : 28 August 2014
                Categories
                Review Article
                Nephrology

                hemodialysis,peritoneal dialysis,survival,mortality
                hemodialysis, peritoneal dialysis, survival, mortality

                Comments

                Comment on this article