In Canada, Similar Outcomes with HD and PD

Nationwide data on Canadian patients with ESRD show similar outcomes for those given peritoneal dialysis (PD) versus hemodialysis (HD), reports a study in Nephrology Dialysis Transplantation.

Using the Canadian Organ Replacement Register, the researchers identified 46,839 patients who started renal replacement therapy from 1991 through 2004. Of these, 69.5 percent were incident on HD and 30.5 percent on PD. Patients were followed up for survival through 2007, with outcomes compared for patients starting dialysis in 1991–1995, 1996–2000, and 2001–2004.

On intention-to-treat analysis across the study period, overall survival was better with PD through the first 18 months but was better with HD after 36 months. For the 2001–2004 cohort, survival was better with PD for the first 2 years, after which there was no significant difference between PD and HD. Peritoneal dialysis was associated with a 27 percent increase in mortality for elderly women (older than 65) with diabetes. As expected, technique survival was lower with PD than with HD, although it improved slightly from the 1991–1995 cohort to the 2001–2004 cohort.

In Canada, the use of PD as the initial dialysis modality has remained relatively stable over time but has decreased in recent years: from 37 percent in 1991 to 18 percent in 2007. The authors used newer statistical models to compare PD and HD survival in a contemporary cohort of incident dialysis patients in Canada.

The results show overall similar survival for ESRD patients receiving PD versus HD. Survival is higher with PD for the first 2 years but is similar thereafter. The authors conclude that “PD and HD should be seen as complementary modalities” offering a choice of treatment approaches for the individual patient [Yeates K, et al. Hemodialysis and peritoneal dialysis are associated with similar outcomes for end-stage renal disease treatment in Canada. Nephrol Dial Transplant 2012; 27:3568–3575].