Peritoneal Dialysis, In-Center Hemodialysis Have Similar Outcomes


TORRANCE, Calif.—Patients beginning their treatment with peritoneal dialysis (PD) had similar outcomes after five years compared to patients using in-center hemodialysis (HD), according to a study published online Sept. 27 in the Archives of Internal Medicine.

“In the largest study to our knowledge to date, we were unable to demonstrate any significant overall difference in outcomes of patients with ESRD who began treatment with either HD or PD in 2002-2004—the most contemporary cohort for which data are available,” the researchers wrote. “Furthermore, progressive improvements in outcomes of PD patients (relative to HD patients) were seen in virtually all of the 8 subgroups examined.”

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In background, the researchers reported that the annual costs of PD are lower than HD—almost $20 000 less. Yet, only 7 percent of U.S. dialysis patients were treated with PD in 2007.  In addition, they pointed out that since 1996, “there has been no change in the first-year mortality of HD patients, but both short- and long-term outcomes of PD patients have improved.”

To look into this matter further, the researchers examined data from the U.S. Renal Data System for survival trends among patients treated with HD and PD. They researched three, three-year cohorts for up to five years for a total of 620,020 HD patients and 64,406 PD patients.

The researches found that for the 2002-2004 cohort, there was no significant difference in the risk of death for HD and PD patients through five years of follow-up. In addition, they found the median life expectancy of HD and PD patients was 38.4 and 36.6 months, respectively.

Also,  age (<65 and 65 years), diabetic status, and baseline comorbidity (none and 1) showed greater improvement in survival among patients treated with PD relative to HD at all follow-up periods, according to the researchers.

PD patients starting  ESRD were younger, more likely to be white, and less likely to have other comorbidities, according to the study. 

“The lower costs of peritoneal dialysis and equivalent outcomes with the 2 therapies provide support for a larger use of PD for the treatment of ESRD in the United States, particularly in subgroups in which the patients treated with PD have similar or lower risk for death when compared with HD (nondiabetic and younger diabetic patients with no additional comorbidity; almost two-thirds of patients with incident ESRD),” the researchers concluded. “However, the improvement in PD outcomes may have been a result of more selective assignment of patients to the therapy over the last decade. Thus, should such an expansion of PD use be undertaken, close monitoring of outcomes of patients treated with different dialysis modalities should continue.”

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