Impact of initial dialysis modality on mortality: a propensity-matched study

BMC Nephrology

Ingrid Os¹  Anna V Reisæter³  Torbjørn Leivestad²  Bård Waldum-Grevbo¹ 

[1] Department of Nephrology, Oslo University Hospital, PB 4956 Nydalen, N-0424, Oslo, Norway;Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway;Section of Nephrology, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway

关键词: Survival analysis;    Prognosis;    Peritoneal dialysis;    Haemodialysis;    ESRD;    Dialysis modality;   

Others  :  1231081
DOI  :  10.1186/s12882-015-0175-5

 received in 2015-06-19, accepted in 2015-10-22,  发布年份 2015

【 摘 要 】

Background

Whether the choice of dialysis modality in patients with end stage renal disease may impact mortality is undecided. No randomized controlled trial has properly addressed this issue. Propensity-matched observational studies could give important insight into the independent effect of peritoneal (PD) opposed to haemodialysis (HD) on all-cause and cardiovascular mortality.

Methods

To correct for case-mix differences between patients treated with PD and HD, propensity-matched analyses were utilized in all patients who initiated dialysis as first renal replacement therapy in Norway in the period 2005–2012. PD patients were matched in a 1:1 fashion with HD patients, creating 692 pairs of patients with comparable baseline variables. As-treated and intention-to treat analyses were undertaken to assess cardiovascular and all-cause mortality. Interaction analyses were used to assess differences in the relationship between initial dialysis modality and mortality, between strata of age, gender and prevalent diabetes mellitus.

Results

In the as-treated analyses, initial dialysis modality did not impact 2-year (PD vs. HD: HR 0.87, 95 % CI 0.67–1.12) or 5-year all-cause mortality (HR 0.95, 95 % CI 0.77–1.17). In patients younger than 65 years, PD was superior compared to HD with regard to both 2-year (HR 0.39, 95 % CI 0.19–0.81), and 5-year all-cause mortality (HR 0.49, 95 % CI 0.27–0.89). Cardiovascular mortality was also lower in the younger patients treated with PD (5-year HR 0.38, 95 % CI 0.15–0.96). PD was not associated with impaired prognosis in any of the prespecified subgroups compared to HD. The results were similar in the as-treated and intention-to-treat analyses.

Conclusion

Survival in PD was not inferior to HD in any subgroup of patients even after five years of follow-up. In patients below 65 years, PD yielded superior survival rates compared to HD. Increased use of PD as initial dialysis modality in ESRD patients could be encouraged.

【 授权许可】

   
2015 Waldum-Grevbo et al.

【 图 表 】

Fig. 1.

Fig. 2.

【 参考文献 】

• [1]Annual Report 2011, the Norwegian Renal Registry. http://www. nephro.no/nnr/AARSM2011.pdf webcite
• [2]Eggers PW. Has the incidence of end-stage renal disease in the USA and other countries stabilized? Curr Opin Nephrol Hypertens. 2011; 20(3):241-245.
• [3]Li PK, Chow KM. Peritoneal dialysis-first policy made successful: perspectives and actions. Am J Kidney Dis. 2013; 62(5):993-1005.
• [4]van de Luijtgaarden MWM, Jager KJ, Stel VS, Kramer A, Cusumano A, Elliott RF, Geue C, MacLeod AM, Stengel B, Covic A et al.. Global differences in dialysis modality mix: the role of patient characteristics, macroeconomics and renal service indicators. Nephrol Dial Transplant. 2013; 28(5):1264-1275.
• [5]Ortiz A, Covic A, Fliser D, Fouque D, Goldsmith D, Kanbay M, Mallamaci F, Massy ZA, Rossignol P, Vanholder R et al.. Epidemiology, contributors to, and clinical trials of mortality risk in chronic kidney failure. Lancet. 2014; 383(9931):1831-1843.
• [6]Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. AmJ Kidney Dis. 1998; 32(5 Suppl 3):S112-S119.
• [7]Yeates K, Zhu N, Vonesh E, Trpeski L, Blake P, Fenton S. Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada. Nephrol Dial Transplant. 2012; 27(9):3568-3575.
• [8]Mehrotra R, Chiu YW, Kalantar-Zadeh K, Bargman J, Vonesh E. Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med. 2011; 171(2):110-118.
• [9]Chang YK, Hsu CC, Hwang SJ, Chen PC, Huang CC, Li TC, Sung FC. A comparative assessment of survival between propensity score-matched patients with peritoneal dialysis and hemodialysis in Taiwan. Medicine. 2012; 91(3):144-151.
• [10]Quinn RR, Hux JE, Oliver MJ, Austin PC, Tonelli M, Laupacis A. Selection bias explains apparent differential mortality between dialysis modalities. J Am Soc Nephrol. 2011; 22(8):1534-1542.
• [11]Vonesh EF, Snyder JJ, Foley RN, Collins AJ. Mortality studies comparing peritoneal dialysis and hemodialysis: What do they tell us? Kidney Int. 2006; 70(S103):S3-S11.
• [12]Weinhandl ED, Foley RN, Gilbertson DT, Arneson TJ, Snyder JJ, Collins AJ. Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol. 2010; 21(3):499-506.
• [13]Lukowsky LR, Mehrotra R, Kheifets L, Arah OA, Nissenson AR, Kalantar-Zadeh K. Comparing mortality of peritoneal and hemodialysis patients in the first 2 years of dialysis therapy: a marginal structural model analysis. Clin J Am Soc Nephrol. 2013; 8(4):619-628.
• [14]Kumar VA, Sidell MA, Jones JP, Vonesh EF. Survival of propensity matched incident peritoneal and hemodialysis patients in a United States health care system. Kidney Int. 2014; 86(5):1016-1022.
• [15]van de Luijtgaarden MW, Noordzij M, Stel VS, Ravani P, Jarraya F, Collart F, Schon S, Leivestad T, Puttinger H, Wanner C et al.. Effects of comorbid and demographic factors on dialysis modality choice and related patient survival in Europe. Nephrol Dial Transplant. 2011; 26(9):2940-2947.
• [16]McDonald SP, Marshall MR, Johnson DW, Polkinghorne KR. Relationship between dialysis modality and mortality. J Am Soc Nephrol. 2009; 20(1):155-163.
• [17]Austin PC. An Introduction to Propensity Score Methods for Reducing the Effects of Confounding in Observational Studies. Mult Behav Res. 2011; 46(3):399-424.
• [18]ERA-EDTA Registry: Annual Report 2012. http://www. era-edta-reg.org/index.jsp?p=14 webcite
• [19]Thoemmes F: Propensity score matching in SPSS. 2012. http://arxiv. org/ftp/arxiv/papers/1201/1201.6385.pdf webcite
• [20]Chaudhary K, Sangha H, Khanna R. Peritoneal dialysis first: rationale. Clin J Am Soc Nephrol. 2011; 6(2):447-456.
• [21]Heaf JG, Wehberg S. Relative survival of peritoneal dialysis and haemodialysis patients: effect of cohort and mode of dialysis initiation. PLoS One. 2014; 9(3):e90119.
• [22]Yohanna S, Alkatheeri AMA, Brimble SK, McCormick B, Iansavitchous A, Blake PG, Jain AK. Effect of Neutral-pH, Low–Glucose Degradation Product Peritoneal Dialysis Solutions on Residual Renal Function, Urine Volume, and Ultrafiltration: A Systematic Review and Meta-Analysis. Clin J Am Soc Nephrol. 2015; 10(8):1380-8.
• [23]Garcia-Lopez E, Lindholm B, Davies S. An update on peritoneal dialysis solutions. Nat Rev Nephrol. 2012; 8(4):224-233.
• [24]Kim H, Kim KH, Park K, Kang SW, Yoo TH, Ahn SV, Ahn HS, Hann HJ, Lee S, Ryu JH et al.. A population-based approach indicates an overall higher patient mortality with peritoneal dialysis compared to hemodialysis in Korea. Kidney Int. 2014; 86(5):991-1000.
• [25]Davies SJ. Peritoneal dialysis[mdash]current status and future challenges. Nat Rev Nephrol. 2013; 9(7):399-408.
• [26]Dalal P, Sangha H, Chaudhary K. In Peritoneal Dialysis, Is There Sufficient Evidence to Make "PD First" Therapy? Int J Nephrol. 2011; 2011:239515.
• [27]Power A, Brown E. Optimising treatment of end-stage renal disease in the elderly. Nephron Clin Pract. 2013; 124(3-4):202-208.
• [28]Da Silva-Gane M, Wellsted D, Greenshields H, Norton S, Chandna SM, Farrington K. Quality of Life and Survival in Patients with Advanced Kidney Failure Managed Conservatively or by Dialysis. Clin J Am Soc Nephrol. 2012; 7(12):2002-2009.
• [29]Stengel B, Billon S, Van Dijk PC, Jager KJ, Dekker FW, Simpson K, Briggs JD. Trends in the incidence of renal replacement therapy for end-stage renal disease in Europe, 1990-1999. Nephrol Dial Transplant. 2003; 18(9):1824-1833.
• [30]Mehrotra R. Changing patterns of peritoneal dialysis utilization in the United States. Perit Dial Int. 2007; 27 Suppl 2:S51-S52.