Mode of dialysis therapy and mortality in end-stage renal disease

Robert N. Foley, Patrick S. Parfrey, John D. Harnett, Gloria M. Kent, Regan O'Dea, David C. Murray, Paul E. Barre

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Abstract

Despite considerable differences in technique and blood purification characteristics, hemodialysis and peritoneal dialysis have been thought to have similar patient outcomes. An inception cohort of 433 end-stage renal disease patients was followed prospectively for a mean of 41 mo. The outcomes of hemodialysis (HD) and peritoneal dialysis (PD) patients were compared using intention to treat analysis based on the mode of therapy at 3 mo. After adjustment for PD patients less likely to have chronic hypertension and more likely to have diabetes, ischemic heart disease, and cardiac failure at baseline (P < 0.05), a biphasic mortality pattern was observed. For the first 2 yr, there was no statistically significant difference in mortality. After 2 yr, mortality was greater among PD patients with an adjusted PDP/HD hazard ratio of 1.57 (95% confidence interval [CI], 0.97 to 2.53). Both the occurrence (adjusted hazards ratio 6.87 [95% CI, 2.01 to 23.5]) and the direction (toward PD, adjusted hazards ratio 6.25 [95% CI, 1.54 to 25]) of a therapy switch were subsequently associated with mortality after 2 yr. Progressive clinical and echocardiographic cardiac disease were not responsible for this late mortality. Lower mean serum albumin levels in PD patients in the first 2 yr of therapy (3.5 ± 0.5 versus 3.9 ± 0.5 g/dl, P < 0.0001) accounted for a large proportion of the increase in subsequent mortality. Hemodialysis has a late survival advantage over peritoneal dialysis; antecedent hypoalbuminemia is a major marker of the increased late mortality in PD patients.

Original languageEnglish (US)
Pages (from-to)267-276
Number of pages10
JournalJournal of the American Society of Nephrology
Volume9
Issue number2
StatePublished - Feb 1 1998

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    Foley, R. N., Parfrey, P. S., Harnett, J. D., Kent, G. M., O'Dea, R., Murray, D. C., & Barre, P. E. (1998). Mode of dialysis therapy and mortality in end-stage renal disease. Journal of the American Society of Nephrology, 9(2), 267-276.