Overestimation of the probability of death on peritoneal dialysis by the Kaplan-Meier method: advantages of a competing risks approach

BMC Nephrology

Research Article

Celia Lessore de Sainte Foy¹  Dominique Pagniez¹  Luc Frimat²  Eric Boulanger³  Julia Salleron⁴  Alain Duhamel⁴  Jean-Baptiste Beuscart⁵ 

[1] Nephrology Department, CHU, Lille, France;Nephrology Department, EA 4003, INSERM CIC-EC CIE6, Nancy University, Nancy, France;University of Lille, Lille, France;University of Lille, Lille, France;Department of Biostatistics, EA2694, UDSL, Lille, France;University of Lille, Lille, France;Department of Biostatistics, EA2694, UDSL, Lille, France;Nephrology Department, CHU, Lille, France;CERIM, EA 2694, Faculty of Medicine, Research Department, 1 Place Verdun, F-59045, Lille, CEDEX, France;

关键词: Chronic Kidney Disease;    Renal Transplantation;    Peritoneal Dialysis;    Cumulative Incidence;    Peritoneal Dialysis Patient;   

DOI  :  10.1186/1471-2369-13-31

 received in 2011-03-25, accepted in 2012-05-14,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundIn survival analysis, patients on peritoneal dialysis are confronted with three different outcomes: transfer to hemodialysis, renal transplantation, or death. The Kaplan-Meier method takes into account one event only, so whether it adequately considers these different risks is questionable. The more recent competing risks method has been shown to be more appropriate in analyzing such situations.MethodsWe compared the estimations obtained by the Kaplan-Meier method and the competing risks method (namely the Kalbfleisch and Prentice approach), in 383 consecutive incident peritoneal dialysis patients. By means of simulations, we then compared the Kaplan-Meier estimations obtained in two virtual centers where patients had exactly the same probability of death. The only difference between these two virtual centers was whether renal transplantation was available or not.ResultsAt five years, 107 (27.9%) patients had died, 109 (28.4%) had been transferred to hemodialysis, 91 (23.8%) had been transplanted, and 37 (9.7%) were still alive on peritoneal dialysis; before five years, 39 (10.2%) patients were censored alive on peritoneal dialysis. The five-year probabilities estimated by the Kaplan-Meier and the competing risks methods were respectively: death: 50% versus 30%; transfer to hemodialysis: 59% versus 32%; renal transplantation: 39% versus 26%; event-free survival: 12% versus 12%. The sum of the Kaplan-Meier estimations exceeded 100%, implying that patients could experience more than one event, death and transplantation for example, which is impossible. In the simulations, the probability of death estimated by the Kaplan-Meier method increased as the probability of renal transplantation increased, although the probability of death actually remained constant.ConclusionThe competing risks method appears more appropriate than the Kaplan-Meier method for estimating the probability of events in peritoneal dialysis in the context of univariable survival analysis.

【 授权许可】

CC BY   
© Beuscart et al.; licensee BioMed Central Ltd. 2012