Initial survival advantage of peritoneal dialysis relative to haemodialysis

Top Cited Papers
Open Access
Publisher Website
Google Scholar
Abstract
Background. The influence of dialysis modality on prognosis is controversial. In the absence of randomized trials, epidemiological investigations present the best method for studying the problem. Methods. 4568 haemodialysis (HD) and 2443 peritoneal dialysis (PD) records in 4921 dialysis patients treated between 1990 and 1999 were retrieved from the Danish Terminal Uremia register in order to determine the influence of dialysis form on prognosis. The register is national, comprehensive, and incident. Results. Factors reducing survival included age, cardiovascular disease, malignancy, lung disease, diabetes, alcoholism, haematological disease, but not sex or hypertension. Transplant non‐candidacy was associated with an adjusted relative risk of 4.7 (CI 4.0–5.6). PD mortality relative to HD (after correction for comorbidity and transplant candidacy) was 0.65 (CI 0.59–0.72, PPvs 5.1 days, PConclusions. These results show a survival advantage for PD during the first 2 years of dialysis treatment. This may be due to unregistered differences in comorbidity at the start of treatment, or may be causal, possibly due to better preservation of residual renal function. The study lends credence to the ‘integrative care’ approach to uraemia, where patients are started on PD and transferred to HD when PD related mortality increases.