For First Few Years, Better Survival with Peritoneal Dialysis than Hemodialysis

Among patients with similar characteristics, those starting peritoneal dialysis (PD) have higher survival through the first 2 or 3 years than do those starting hemodialysis (HD), reports a study in Kidney International.

Using their managed care system’s ESRD registry, the researchers identified 11,301 patients who were beginning PD or HD. From this group, 1003 propensity-matched pairs of incident PD and HD patients were identified. Eligible HD patients received appropriate predialysis care, including permanent dialysis access placement. Survival was compared by intention-to-treat and as-treated analyses.

The 1-year adjusted survival was 95 percent in the PD group versus 89 percent in the HD group; the 2-year survival was 87 percent versus 83 percent, respectively. The 1-year cumulative hazard ratio for death among incident HD patients, compared with PD, was 2.38 on intention-to-treat analysis and 2.10 on as-treated analysis.

The risk of death remained lower with PD through close to 3 years on as-treated analysis and nearly 2 years on intention-to-treat analysis. There was no significant difference in mortality on longer follow-up.

Studies comparing survival in incident HD and PD patients have reported conflicting results. Reports of improved survival in patients beginning PD might reflect the effects of early central venous catheter use or other potential confounders.

This new propensity-matched analysis finds a significant survival advantage with PD over the first 2 or 3 years. In the first year, the cumulative risk of death is more than twice as high with HD. The authors suggest that ongoing improvements in the treatment of PD patients and avoidance of metabolic complications might lead to a longer duration of survival benefit [Kumar VA, et al. Survival of propensity matched incident peritoneal and hemodialysis patients in a United States health care system. Kidney Int 2014; 86:1016–1022].