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Multicenter Study
. 2023 May;27(5):419-426.
doi: 10.1007/s10157-023-02315-3. Epub 2023 Jan 23.

Comparison of survival rates between incident hemodialysis patients and peritoneal dialysis patients: a 5-year prospective cohort study with propensity score matching

Mami Miyazaki  1 , Kensuke Sasaki  2 , Ayumu Nakashima  1   3 , Akira Takahashi  1 , Naoki Ishiuchi  1 , Ryo Tamura  1 , Yosuke Osaki  1 , Shigehiro Doi  1 , Takao Masaki  4
Affiliations
Multicenter Study

Comparison of survival rates between incident hemodialysis patients and peritoneal dialysis patients: a 5-year prospective cohort study with propensity score matching

Mami Miyazaki et al. Clin Exp Nephrol. 2023 May.

Abstract

Background: The effect of dialytic modality at the start of renal replacement therapy on prognosis is controversial.

Methods: This multicenter, prospective cohort study included patients undergoing incident hemodialysis (HD) (n = 646) and peritoneal dialysis (PD) (n = 72). We excluded patients who lacked complete data for 3 months. One-to-one propensity score (PS) matching was performed before between-group comparison of survival rates (Kaplan-Meier method and log-rank test) and identification of factors affecting prognosis (Cox proportional-hazards regression analysis).

Results: We enrolled 621 and 71 patients undergoing HD and PD, respectively (overall mean ± standard deviation age: 74 ± 13 years); 20% had cardiovascular disease (CVD). The median follow-up period was 41 (interquartile range 24-66) months. Following PS matching, we analyzed 65 patients undergoing HD and PD each. The 5-year overall survival rates did not differ between the groups (P = 0.97). The PD group exhibited a better CVD-related survival rate (P = 0.03). PD yielded adjusted hazard ratios for all-cause and CVD-related mortality of 0.99 (95% confidence interval [CI] 0.49-1.99, P = 0.97) and 3.92 (95% CI 1.05-14.7, P = 0.04), respectively. Age (P < 0.001) and the use of a central venous catheter (CVC) at dialytic initiation (P = 0.02) were independent risks for all-cause mortality; whereas, only the use of a CVC (P = 0.01) was an independent risk for CVD-related mortality.

Conclusion: Although no differences were observed in overall survival, CVD-related survival may be better with dialytic initiation with PD than with HD.

Keywords: Hemodialysis; Peritoneal dialysis; Propensity score-matched analysis; Survival rates.

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