Introduction Epidemiological studies consistently show an initial survival advantage for PD patients compared to HD. It has recently been suggested that this is due to the fact that many HD patients are referred late, and start dialysis on an acute, in-patient basis. The present study was performed to investigate (1) whether, and if so, how, PD and HD prognosis had changed in recent years, (2) whether a potential survival advantage of PD versus HD is constant over dialysis duration, and (3) whether differences in prognosis could be explained by patient age, renal diagnosis of diabetic nephropathy, or mode of dialysis initiation. Patients and Methods 12095 patients starting dialysis therapy between 1990 and 2010 in Denmark were studied. Prognosis was assessed according to initial dialysis modality on an intention-to-treat basis, censored for transplantation. Results were adjusted for age, sex, renal diagnosis, Charlson Comorbidity Index (CCI), and mode of dialysis initiation. Results Overall adjusted prognosis improved by 34% (HD 30%, PD 42%). PD prognosis relative to HD improved, and was 16% better at the end of the period. Final PD prognosis improved consistently from 1990–99 to 2000–10 in all subgroups. PD was associated with a significant initial survival advantage, both overall and for all subgroups For the latter cohort, overall PD prognosis was better than HD for the first 4 years, after which it was insignificantly worse. The initial survival advantage was also present in a subgroup analysis of patients with early & routine ESRD initiation. Conclusions Dialysis survival has increased during the past 20 years. PD survival since 2000 has been better than HD, overall and for all subgroups. The difference in survival is not explained by mode of dialysis initiation.
References
[1]
Fenton SS, Schaubel DE, Desmeules M, Morrison HI, Mao Y, et al. (1997) Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis 30: 334–342 S0272638697001686 [pii]. doi: 10.1016/s0272-6386(97)90276-6
[2]
Schaubel DE, Morrison HI, Fenton SS (1998) Comparing mortality rates on CAPD/CCPD and hemodialysis. The Canadian experience: fact or fiction? Perit Dial Int 18: 478–484.
[3]
Vonesh EF, Moran J (1999) Mortality in end-stage renal disease: a reassessment of differences between patients treated with hemodialysis and peritoneal dialysis. J Am Soc Nephrol 10: 354–365.
[4]
Locatelli F, Marcelli D, Conte F, D'Amico M, Del VL, et al. (2001) Survival and development of cardiovascular disease by modality of treatment in patients with end-stage renal disease. J Am Soc Nephrol 12: 2411–2417.
[5]
Heaf JG, Lokkegaard H, Madsen M (2002) Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant 17: 112–117. doi: 10.1093/ndt/17.1.112
[6]
Winkelmayer WC, Glynn RJ, Mittleman MA, Levin R, Pliskin JS, et al. (2002) Comparing mortality of elderly patients on hemodialysis versus peritoneal dialysis: a propensity score approach. J Am Soc Nephrol 13: 2353–2362. doi: 10.1097/01.asn.0000025785.41314.76
[7]
Collins AJ, Weinhandl E, Snyder JJ, Chen SC, Gilbertson D (2002) Comparison and survival of hemodialysis and peritoneal dialysis in the elderly. Semin Dial 15: 98–102 0032 [pii]. doi: 10.1046/j.1525-139x.2002.00032.x
[8]
Termorshuizen F, Korevaar JC, Dekker FW, Van Manen JG, Boeschoten EW, et al. (2003) Hemodialysis and peritoneal dialysis: comparison of adjusted mortality rates according to the duration of dialysis: analysis of The Netherlands Cooperative Study on the Adequacy of Dialysis 2. J Am Soc Nephrol 14: 2851–2860. doi: 10.1097/01.asn.0000091585.45723.9e
[9]
Ganesh SK, Hulbert-Shearon T, Port FK, Eagle K, Stack AG (2003) Mortality differences by dialysis modality among incident ESRD patients with and without coronary artery disease. J Am Soc Nephrol 14: 415–424. doi: 10.1097/01.asn.0000043140.23422.4f
[10]
Stack AG, Molony DA, Rahman NS, Dosekun A, Murthy B (2003) Impact of dialysis modality on survival of new ESRD patients with congestive heart failure in the United States. Kidney Int 64: 1071–1079 kid165 [pii];10.1046/j.1523-1755.2003.00165.x [doi]. doi: 10.1046/j.1523-1755.2003.00165.x
[11]
Vonesh EF, Snyder JJ, Foley RN, Collins AJ (2004) The differential impact of risk factors on mortality in hemodialysis and peritoneal dialysis. Kidney Int 66: 2389–2401 KID66028 [pii];10.1111/j.1523-1755.2004.66028.x [doi]. doi: 10.1111/j.1523-1755.2004.66028.x
[12]
Jaar BG, Coresh J, Plantinga LC, Fink NE, Klag MJ, et al. (2005) Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease. Ann Intern Med 143: 174–183 143/3/174 [pii]. doi: 10.7326/0003-4819-143-3-200508020-00003
[13]
Frimat L, Durand PY, Loos-Ayav C, Villar E, Panescu V, et al. (2006) Impact of first dialysis modality on outcome of patients contraindicated for kidney transplant. Perit Dial Int 26: 231–239.
[14]
Mircescu G, Garneata L, Florea L, Cepoi V, Capsa D, et al. (2006) The success story of peritoneal dialysis in Romania: analysis of differences in mortality by dialysis modality and influence of risk factors in a national cohort. Perit Dial Int 26: 266–275.
[15]
Liem YS, Wong JB, Hunink MG, de Charro FT, Winkelmayer WC (2007) Comparison of hemodialysis and peritoneal dialysis survival in The Netherlands. Kidney Int 71: 153–158 5002014 [pii];10.1038/sj.ki.5002014 [doi]. doi: 10.1038/sj.ki.5002014
[16]
Huang CC, Cheng KF, Wu HD (2008) Survival analysis: comparing peritoneal dialysis and hemodialysis in Taiwan. Perit Dial Int 28 Suppl 3: S15–S20 28/Supplement_3/S15 [pii].
[17]
Sanabria M, Munoz J, Trillos C, Hernandez G, Latorre C, et al. (2008) Dialysis outcomes in Colombia (DOC) study: a comparison of patient survival on peritoneal dialysis vs hemodialysis in Colombia. Kidney Int Suppl: S165–S172 5002619 [pii];10.1038/sj.ki.5002619 [doi]. doi: 10.1038/sj.ki.5002619
[18]
Lee CC, Sun CY, Wu MS (2009) Long-term modality-related mortality analysis in incident dialysis patients. Perit Dial Int 29: 182–190 29/2/182 [pii].
[19]
McDonald SP, Marshall MR, Johnson DW, Polkinghorne KR (2009) Relationship between dialysis modality and mortality. J Am Soc Nephrol 20: 155–163 ASN.2007111188 [pii];10.1681/ASN.2007111188 [doi]. doi: 10.1681/asn.2007111188
[20]
Weinhandl ED, Foley RN, Gilbertson DT, Arneson TJ, Snyder J, et al. (2010) Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol 21: 499–506 ASN.2009060635 [pii];10.1681/ASN.2009060635 [doi]. doi: 10.1681/asn.2009060635
[21]
van de Luijtgaarden MW, Noordzij M, Stel VS, Ravani P, Jarraya F, et al. (2011) Effects of comorbid and demographic factors on dialysis modality choice and related patient survival in Europe. Nephrol Dial Transplant 26: 2940–2947 gfq845 [pii];10.1093/ndt/gfq845 [doi]. doi: 10.1093/ndt/gfq845
[22]
Quinn RR, Hux JE, Oliver MJ, Austin PC, Tonelli M, et al. (2011) Selection bias explains apparent differential mortality between dialysis modalities. J Am Soc Nephrol 22: 1534–1542 ASN.2010121232 [pii];10.1681/ASN.2010121232 [doi]. doi: 10.1681/asn.2010121232
[23]
Mehrotra R, Chiu YW, Kalantar-Zadeh K, Bargman J, Vonesh E (2011) Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med 171: 110–118 archinternmed.2010.352 [pii];10.1001/archinternmed.2010.352 [doi]. doi: 10.1001/archinternmed.2010.352
[24]
Sens F, Schott-Pethelaz AM, Labeeuw M, Colin C, Villar E (2011) Survival advantage of hemodialysis relative to peritoneal dialysis in patients with end-stage renal disease and congestive heart failure. Kidney Int 80: 970–977 ki2011233 [pii];10.1038/ki.2011.233 [doi]. doi: 10.1038/ki.2011.233
[25]
Yeates K, Zhu N, Vonesh E, Trpeski L, Blake P, et al. (2012) Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada. Nephrol Dial Transplant 27: 3568–3575 gfr674 [pii];10.1093/ndt/gfr674 [doi]. doi: 10.1093/ndt/gfr674
[26]
Wehberg S (2010) Datagrundlag og analysemetode. Danish Nephrology Registry Annual Report 2009. Available: www.nephrology.dk: 14–21. Accessed 2014 Feb 8.
[27]
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40: 373–383. doi: 10.1016/0021-9681(87)90171-8
[28]
Lynge E, Sandegaard JL, Rebolj M (2011) The Danish National Patient Register. Scand J Public Health 39: 30–33 39/7_suppl/30 [pii];10.1177/1403494811401482 [doi]. doi: 10.1177/1403494811401482
[29]
Pedersen CB, Gotzsche H, Moller JO, Mortensen PB (2006) The Danish Civil Registration System. A cohort of eight million persons. Dan Med Bull 53: 441–449 DMB3816 [pii].
[30]
Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH (1999) The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull 46: 263–268.
[31]
Grambsch PM, Therneau TM (2010) Proportional hazards tests and diagnostics based on weighted residuals. Biometrika 81: 515–526. doi: 10.1093/biomet/81.3.515
[32]
Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C, et al. (2012) 'United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease & end-stage renal disease in the United States. Am J Kidney Dis 59: A7, e1–A7,420 S0272-6386(11)01571-X [pii];10.1053/j.ajkd.2011.11.015 [doi]. doi: 10.1053/j.ajkd.2004.10.009
[33]
Port FK, Pisoni RL, Bommer J, Locatelli F, Jadoul M, et al. (2006) Improving outcomes for dialysis patients in the international Dialysis Outcomes and Practice Patterns Study. Clin J Am Soc Nephrol 1: 246–255 CJN.01050905 [pii];10.2215/CJN.01050905 [doi].
[34]
Churchill DN, Thorpe KE, Nolph KD, Keshaviah PR, Oreopoulos DG, et al. (1998) Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 9: 1285–1292.
[35]
Brimble KS, Walker M, Margetts PJ, Kundhal KK, Rabbat CG (2006) Meta-analysis: peritoneal membrane transport, mortality, and technique failure in peritoneal dialysis. J Am Soc Nephrol 17: 2591–2598 ASN.2006030194 [pii];10.1681/ASN.2006030194 [doi]. doi: 10.1681/asn.2006030194
[36]
Yang X, Fang W, Bargman JM, Oreopoulos DG (2008) High peritoneal permeability is not associated with higher mortality or technique failure in patients on automated peritoneal dialysis. Perit Dial Int 28: 92. [pii].
[37]
Johnson DW, Hawley CM, McDonald SP, Brown FG, Rosman JB, et al. (2010) Superior survival of high transporters treated with automated versus continuous ambulatory peritoneal dialysis. Nephrol Dial Transplant 25: 1973–1979 gfp780 [pii];10.1093/ndt/gfp780 [doi]. doi: 10.1093/ndt/gfp780
[38]
Davies SJ (2006) Mitigating peritoneal membrane characteristics in modern peritoneal dialysis therapy. Kidney Int Suppl: S76–S83 5001920 [pii];10.1038/sj.ki.5001920 [doi]. doi: 10.1038/sj.ki.5001920
Johnson DW, Brown FG, Clarke M, Boudville N, Elias TJ, et al. (2012) Effects of biocompatible versus standard fluid on peritoneal dialysis outcomes. J Am Soc Nephrol 23: 1097–1107 ASN.2011121201 [pii];10.1681/ASN.2011121201 [doi]. doi: 10.1681/asn.2011121201
[41]
Johnson DW, Brown FG, Clarke M, Boudville N, Elias TJ, et al. (2012) The effect of low glucose degradation product, neutral pH versus standard peritoneal dialysis solutions on peritoneal membrane function: the balANZ trial. Nephrol Dial Transplant 27: 4445–4453 gfs314 [pii];10.1093/ndt/gfs314 [doi]. doi: 10.1093/ndt/gfs314
[42]
Lang SM, Bergner A, Topfer M, Schiffl H (2001) Preservation of residual renal function in dialysis patients: effects of dialysis-technique-related factors. Perit Dial Int 21: 52–57.
[43]
Vilar E, Wellsted D, Chandna SM, Greenwood RN, Farrington K (2009) Residual renal function improves outcome in incremental haemodialysis despite reduced dialysis dose. Nephrol Dial Transplant 24: 2502–2510 gfp071 [pii];10.1093/ndt/gfp071 [doi]. doi: 10.1093/ndt/gfp071
[44]
Eknoyan G, Beck GJ, Cheung AK, Daugirdas JT, Greene T, et al. (2002) Effect of dialysis dose and membrane flux in maintenance hemodialysis. N Engl J Med 347: 2010–2019 10.1056/NEJMoa021583 [doi];347/25/2010 [pii].
[45]
Grooteman MP, van den Dorpel MA, Bots ML, Penne EL, van der Weerd NC, et al. (2012) Effect of online hemodiafiltration on all-cause mortality and cardiovascular outcomes. J Am Soc Nephrol 23: 1087–1096 ASN.2011121140 [pii];10.1681/ASN.2011121140 [doi]. doi: 10.1681/asn.2011121140
[46]
Moist LM, Port FK, Orzol SM, Young EW, Ostbye T, et al. (2000) Predictors of loss of residual renal function among new dialysis patients. J Am Soc Nephrol 11: 556–564.
[47]
Jansen MA, Hart AA, Korevaar JC, Dekker FW, Boeschoten EW, et al. (2002) Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney Int 62: 1046–1053 kid505 [pii];10.1046/j.1523-1755.2002.00505.x [doi]. doi: 10.1046/j.1523-1755.2002.00505.x
[48]
Paniagua R, Amato D, Vonesh E, Correa-Rotter R, Ramos A, et al. (2002) Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 13: 1307–1320.
[49]
Marshall MR, Hawley CM, Kerr PG, Polkinghorne KR, Marshall RJ, et al. (2011) Home hemodialysis and mortality risk in Australian and New Zealand populations. Am J Kidney Dis 58: 782–793 S0272-6386(11)00942-5 [pii];10.1053/j.ajkd.2011.04.027 [doi]. doi: 10.1053/j.ajkd.2011.04.027
[50]
Burton JO, Jefferies HJ, Selby NM, McIntyre CW (2009) Hemodialysis-induced cardiac injury: determinants and associated outcomes. Clin J Am Soc Nephrol 4: 914–920 CJN.03900808 [pii];10.2215/CJN.03900808 [doi]. doi: 10.2215/cjn.03900808
[51]
Foley RN, Gilbertson DT, Murray T, Collins AJ (2011) Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med 365: 1099–1107 10.1056/NEJMoa1103313 [doi].
[52]
Pauly RP, Gill JS, Rose CL, Asad RA, Chery A, et al. (2009) Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant 24: 2915–2919 gfp295 [pii];10.1093/ndt/gfp295 [doi]. doi: 10.1093/ndt/gfp295
