A comparison of mortality between patients treated with hemodialysis and peritoneal dialysis

Abstract

Patients with ESRD treated with dialysis have a high mortality rate. Controversy exists as to whether this high mortality rate is affected by modality choice. The purpose of this epidemiologic study was to compare mortality In prevalent hemodialysis-treated (HD) and peritoneal dialysis-treated (PD) patients in a large national sample, adjusting for demographic characteristics. Data were obtained from the U.S. Renal Data System for patients prevalent on January 1 of the years 1987, 1988, and 1989, each with 1 yr of followup. Patients were censored at transplantation. Death rates per 100 patient years were compared between HD and PD, adjusting for age, race, gender, cause of ESRD (diabetes versus nondiabetes) and <1 yr or >1 yr of prior ESRD, by the use of Poisson regression. There were 42,372 deaths occurring over 170,700 patient years at risk. On average, prevalent patients treated with PD had a 19% higher adjusted mortality risk (relative risk (RR) = 1.19; P < 0.001) than did those treated with HD. This risk was found to be Insignificant (P > 0.05) and small for ages <55 and increasingly large and significant for ages >55 yr. It was accentuated in diabetics (RR = 1.38, P < 0.001) but was also present in nondiabetics (RR = 1.11; P < 0.001). Although present In both males and females, this risk was accentuated In females (RR = 1.30 versus 1.11; both P < 0.001). In this national study of prevalent U.S. dialysis patients, treatment assignment to PD was associated with a 19% higher all-cause mortality rate than HD. Further studies are necessary to separate the effect of patient selection, differentia[ dose of dialysis, nutrition, patient compliance, and/or medica[ quality of care from a possible true adverse treatment effect of PD.