Original InvestigationMortality risks of peritoneal dialysis and hemodialysis★
Section snippets
Methods
Medicare eligibility for ESRD patients was determined through a complex set of requirements. In-center hemodialysis patients who were at least 65 years old, who were medically disabled, or who had railroad retirement insurance received Medicare entitlement from the first day of ESRD onset. In-center hemodialysis patients who did not meet any of these criteria, however, had to wait 90 days for Medicare eligibility. In addition, in-center hemodialysis patients with employer group health plans
Modality distribution
Table 1 shows the distribution of patients by modality, age, gender, and race.
Empty Cell HD (n = 99,048) CAPD/CCPD (n = 18,110) P NDM (%) DM (%) NDM (%) DM (%) Female <55 White 66.3 69.6 33.7 30.4 0.010 Black 78.5 83.2 21.5 16.8 0.001 Other 67.1 74.6 32.9 25.4 0.003 55+ White 85.6 85.2 14.4 14.8 0.306 Black 92.9 92.2 7.1 7.8 0.084 Other 89.9 89.7 10.1 10.3 0.856 Male <55 White 71.2 72.1 28.8 27.9 0.392 Black 84.5 85.2 15.5 13.8 0.511 Other 76.7 84.7 23.3 15.3
Discussion
Using a Poisson regression, we found that outcomes for incident patients on CAPD/CCPD were comparable with or significantly better than those of hemodialysis patients within the first 2 years of follow-up. Our Cox regression analysis, which separated patients by diabetic status, showed that CAPD/CCPD had significantly lower risks in nondiabetic patients, comparable risks in most diabetics, and higher risks only in female diabetics 55 years of age and older.
Our analysis did not confirm the
Conclusion
Our analysis of a pure incident dialysis population indicates that, within the first 2 years of follow-up, nondiabetics have significantly better outcomes overall on CAPD/CCPD than on hemodialysis, as do younger diabetic patients. The greater mortality risk for older female diabetic patients, noted not only in our study but in that of Vonesh and Moran, suggests that these patients may be at risk for infectious complications, a finding that should be more carefully evaluated. Our results also
Acknowledgements
Acknowledgment: The authors thank Dana D. Knopic for manuscript preparation and management of the regulatory elements of the HCFA data and Shu Chen for preparing the analytical files.
References (26)
- et al.
Urea index and other predictors of hemodialysis patient survival
Am J Kidney Dis
(1994) - et al.
Survival of hemodialysis patients in the United States is improved with a greater quantity of dialysis
Am J Kidney Dis
(1994) - et al.
Hemodialysis versus peritoneal dialysis: A comparison of adjusted mortality rates
Am J Kidney Dis
(1997) - et al.
Kinetic modeling of peritoneal transport
Contrib Nephrol
(1979) - et al.
Additional experience with continuous ambulatory peritoneal dialysis (CAPD)
Trans Am Soc Artif Intern Organs
(1978) - et al.
Theoretical and practical implications of continuous ambulatory peritoneal dialysis
Nephron
(1978) - et al.
Final Guideline Summaries From the Work Groups of the National Kidney Foundation—Dialysis Outcomes Quality Initiative
(1997) - et al.
Lower probability of patient survival with continuous peritoneal dialysis in the United States compared with Canada
J Am Soc Nephrol
(1997) - et al.
The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis
N Engl J Med
(1993) - et al.
A comparison of mortality between patients treated with hemodialysis and peritoneal dialysis
J Am Soc Nephrol
(1995)
Mortality in end-stage renal disease: A reassessment of differences between patients treated with hemodialysis and peritoneal dialysis
J Am Soc Nephrol
USRDS 1998 Annual Data Report
Prognostic factors, models and related statistical problems in the survival of end-stage renal disease patients on hemodialysis
Stat Med
Cited by (330)
Comparative analysis of hemodialysis and peritoneal dialysis on the risk of new onset diabetes mellitus
2024, Journal of the Formosan Medical AssociationCharacteristics of registered research in peritoneal dialysis: Past and present
2024, Clinical NephrologyDo we practice what we preach? Dialysis modality choice among healthcare workers in the United Kingdom
2023, Seminars in DialysisCharacteristics and 1-year survival of incident patients on chronic peritoneal dialysis compared with hemodialysis:a large 11-year cohort study
2023, International Urology and Nephrology
Received April 5, 1999; accepted in revised form July 2, 1999.
Supported in part through an unrestricted research grant from the Minneapolis Medical Research Foundation and Baxter Healthcare Corporation, McGaw Park, IL.
- ★
Address reprint requests to Allan J. Collins, MD, Nephrology Analytical Services, 914 South 8th Street, Suite-D206, Minneapolis, MN 55404. E-mail: [email protected]