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. 2018 Oct 16;4(2):275-284.
doi: 10.1016/j.ekir.2018.10.008. eCollection 2019 Feb.

Early Mortality Among Peritoneal Dialysis and Hemodialysis Patients Who Transitioned With an Optimal Outpatient Start

Hui Zhou  1 , John J Sim  2 , Simran K Bhandari  2 , Sally F Shaw  1 , Jiaxiao Shi  1 , Scott A Rasgon  2 , Csaba P Kovesdy  3 , Kamyar Kalantar-Zadeh  4 , Michael H Kanter  5 , Steven J Jacobsen  1
Affiliations

Early Mortality Among Peritoneal Dialysis and Hemodialysis Patients Who Transitioned With an Optimal Outpatient Start

Hui Zhou et al. Kidney Int Rep. .

Abstract

Introduction: Lower early mortality observed in peritoneal dialysis (PD) compared with hemodialysis (HD) may be due to differential pre-end-stage renal disease (ESRD) care and the stable setting of transition to dialysis where PD starts are more frequently outpatient rather than during an unscheduled hospitalization. To account for these circumstances, we compared early mortality among a matched cohort of PD and HD patients who had optimal and outpatient starts.

Methods: Retrospective cohort study performed among patients with chronic kidney disease (CKD) who transitioned to ESRD from 1 January 2002 to 31 March 2015 with an optimal start in an outpatient setting. Optimal start defined as (i) HD with an arteriovenous graft or fistula or (ii) PD. Propensity score modeling factoring age, race, sex, comorbidities, estimated glomerular filtration rate (eGFR) level, and change in eGFR before ESRD was used to create a matched cohort of HD and PD. All-cause mortality was compared at 6 months, 1 year, and 2 years posttransition to ESRD.

Results: Among 2094 patients (1398 HD and 696 PD) who had optimal outpatient transition to ESRD, 541 HD patients were propensity score-matched to 541 PD patients (caliper distance <0.001). All-cause mortality odds ratios (OR) in PD compared with HD were 0.79 (0.39-1.63), 0.73 (0.43-1.23), and 0.88 (0.62-1.26) for 6 months, 1 year, and 2 years, respectively. Time-varying analysis accounting for modality switch (19% PD, 1.9% HD) demonstrated a mortality hazard ratio of 0.94 (0.70-1.24).

Conclusion: Among an optimal start CKD cohort that transitioned to ESRD on an outpatient basis, we found no evidence of differences in early mortality between PD and HD.

Keywords: hemodialysis; mortality; optimal end-stage renal disease transition; peritoneal dialysis; propensity-matched cohort.

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Figures

None
Graphical abstract
Figure 1
Figure 1
Study population. Among 5423 patients with chronic kidney disease (CKD) with 6-month continuous membership, information on pre–end-stage renal disease (ESRD) estimated glomerular filtration rate (eGFR), and identified dialysis modality, 2094 patients transitioned to ESRD with an optimal start and in an outpatient setting. Propensity score matching, which accounted for age, sex, acute kidney injury within 90 days before ESRD, eGFR before dialysis, diabetes, congestive heart failure, Charlson comorbidity index, and bicarbonate, generated a peritoneal dialysis (PD) (541) and hemodialysis (HD) (541) cohort who were similar in characteristics and likely to receive either modality.
Figure 2
Figure 2
Monthly crude mortality rates (deaths per 1000 patient years) by modality type in 2 years after end-stage renal disease (ESRD) transition among 2094 total unmatched population with HD (1398) and peritoneal dialysis (PD) (696) patients.
Figure 3
Figure 3
Kaplan-Meier survival curve comparing mortality in the 2 years after end-stage renal disease transition among propensity score–matched peritoneal dialysis (PD) (541) and hemodialysis (HD) (541) patients.
Figure 4
Figure 4
Among the propensity-matched cohorts, crude and adjusted odds ratio of mortality in peritoneal dialysis (PD) versus hemodialysis (HD) at 6 months, 1 year, or 2 years. Adjusted odds ratios accounted for age, sex, and race/ethnicity. CI, confidence interval.
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References

    1. Kalantar-Zadeh K., Kovesdy C.P., Streja E. Transition of care from pre-dialysis prelude to renal replacement therapy: the blueprints of emerging research in advanced chronic kidney disease. Nephrol Dial Transplant. 2017;32(suppl 2):ii91–ii98. - PMC - PubMed
    1. Saran R., Li Y., Robinson B. US Renal Data System 2015 Annual Data Report:Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2016;67(Svii):S1–S305. - PMC - PubMed
    1. Saran R., Robinson B., Abbott K.C. US Renal Data System 2016 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2017;69:A7–A8. - PMC - PubMed
    1. Foley R.N., Chen S.C., Solid C.A. Early mortality in patients starting dialysis appears to go unregistered. Kidney Int. 2014;86:392–398. - PubMed
    1. Chan K.E., Maddux F.W., Tolkoff-Rubin N. Early outcomes among those initiating chronic dialysis in the United States. Clin J Am Soc Nephrol. 2011;6:2642–2649. - PMC - PubMed