Peritoneal dialysis: update on patient survival

Abstract

Due to ongoing limitations in the availability and timeliness of kidney transplantation, most patients with end-stage renal disease (ESRD) require some form of dialysis during their lifetime. Worldwide, ESRD patients most commonly receive hemodialysis (HD) or one of two forms of peritoneal dialysis (PD), continuous ambulatory PD (CAPD) or automated PD (APD). In this review, we analyze the data available from the last several decades on overall survival associated with HD as compared to PD as well as with CAPD compared to APD. Because of the inherent difficulty in randomly assigning patients to different dialysis modalities, the survival data available are virtually all observational and fraught with many confounding factors and limitations. However, over the last 10 - 15 years as overall survival of dialysis patients has steadily improved and statistical methods to analyze observational data have evolved, a pattern of virtual equivalence in survival among patients on HD vs. PD and on CAPD vs. APD has emerged. As such, impact upon lifestyle and upon quality of life likely should remain the predominant factors in guiding nephrologists and their patients in their choice of dialysis modality.

Figure 1.. Patient survival by dialysis modality. Adjusted population survival curves comparing the outcome of PD and HD patients from a large US cohort with incident ESRD from 2002 to 2004. From reference [4] with permission. ESRD = end-stage renal disease; HD = hemodialysis; PD = peritoneal dialysis.

Figure 2.. Kaplan-Meier curves of comparative survivals by univariate analysis of incident peritoneal dialysis patients on APD vs. CAPD in New Zealand and Australia. From reference [46] with permission. APD = automatic peritoneal dialysis; CAPD = continuous ambulatory peritoneal dialysis.