Clinical Investigation

Kidney International (1994) 45, 1163–1169; doi:10.1038/ki.1994.154

Continuous ambulatory peritoneal dialysis and hemodialysis: Comparison of patient mortality with adjustment for comorbid conditions

Philip J Held, Friedrich K Port, Marc N Turenne, Daniel S Gaylin, Richard J Hamburger and Robert A Wolfe

The United States Renal Data System, Bethesda, Maryland; Departments of Medicine, Health Services Management and Policy, and Epidemiology, and Biostatistics, University of Michigan, Ann Arbor, Michigan; Princeton University, Princeton, New Jersey; and Indiana University Medical Center, Indianapolis, Indiana, USA

Correspondence: Philip J Held PhD, University of Michigan, 315 W. Huron #240, Ann Arbor, Michigan 48103, USA.

Received 2 April 1993; Revised 28 October 1993; Accepted 28 October 1993.

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Abstract

Continuous ambulatory peritoneal dialysis and hemodialysis: Comparison of patient mortality with adjustment for comorbid conditions. A historical prospective national sample of 1,725 diabetic and 2,411 non-diabetic Medicare end-stage renal disease (ESRD) patients incident from 1986 to 1987 was analyzed for the mortality of patients selected to receive continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD) with adjustment for patient characteristics, including the presence of comorbid conditions at onset of ESRD. Cox proportional hazards analyses were used to compare the mortality of CAPD and HD patients. Patients were followed from 30 days following onset of ESRD until two to four years post-onset. No statistically significant difference in relative mortality risk (RR) was found among non-diabetic patients selected for CAPD compared to HD (RR = 0.84 for CAPD versus HD, P = 0.25), while evidence of higher adjusted mortality for CAPD compared to HD was found among diabetic patients (RR = 1.26, P = 0.03). Mortality analyses adjusted for pre-treatment risk factors suggest that CAPD and HD provide incident non-diabetic ESRD patients with similar expected survival outcomes. Evidence that increased mortality was associated with CAPD among diabetic patients, particularly among elderly patients, suggests the need for further controlled studies of mortality among CAPD patients with diabetes.

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References

  1. U.S. Renal Data System. USRDS 1993 Annual Data Report. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, 1993
  2. U.S. Renal Data System: Patient selection to peritoneal dialysis versus hemodialysis according to comorbid conditions. Am J Kidney Dis 20(Suppl 2):20–26, 1992
  3. Maiorca R, Vonesh EF, Cavalli P, De Vecchi A, Giangrande A, La Greca G, Scarpioni LL, Bragantini L, Cancarini GC, Cantaluppi A, Castelnovo C, Castiglioni A, Poisetti P, Viglino G: A multi-center, selection-adjusted comparison of patient and technique survivals on CAPD and hemodialysis. Pent Dial Int 11:118–127, 1991
  4. Gentil MA, Carriazo A, Pavon MI, Rosado M, Castillo D, Ramos B, Algarra GR, Tejuca F, Banasco VP, Milan JA: Comparison of survival in continuous ambulatory peritoneal dialysis and hospital haemodialysis: A multicentric study. Nephrol Dial Transplant 6:444–451, 1991 | PubMed | ISI | ChemPort |
  5. Serkes KD, Blagg CR, Nolph KD, Vonesh EF, Shapiro F: Comparison of patient and technique survival in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis: A multicenter study. Pent Dial Int 10:15–19, 1990
  6. Gokal R, Jakubowski C, King J, Hunt L, Bogle S, Baillod R, Marsh F, Ogg C, Oliver D, Ward M, Wilkinson R: Outcome in patients on continuous ambulatory peritoneal dialysis and hemodialysis: 4-year analysis of a prospective multicentre study. Lancet 2:1105–1109, 1987 | PubMed | ISI | ChemPort |
  7. U.S. Renal Data System: Comorbid conditions and correlations with mortality risk among 3,399 incident hemodialysis patients. Am J Kidney Dis 20(Suppl 2):32–38, 1992
  8. U.S. Renal Data System: USRDS 1992 Annual Data Report. The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, August 1992
  9. Wolfe RA, Port FK, Hawthorne VM, Guire KE: A comparison of survival among dialytic therapies of choice: In-center hemodialysis versus continuous ambulatory peritoneal dialysis at home. Am J Kidney Dis 15:433–440, 1990 | PubMed | ISI | ChemPort |
  10. Held PJ, Garcia JR, Blagg CR, Wolfe RA, Eggers PW, Port FK, FitzSimmons SC: Trends in mortality rates among dialysis and transplant patients in the U.S. (abstract) Kidney Int 37:239, 1990
  11. Held PJ, Port FK, Gaylin DS, Wolfe RA, Levin NW, Blagg CR, Garcia JR, Agodoa LY: Evaluation of initial predictors of mortality among new ESRD patients: The USRDS case mix study. (abstract) J Am Soc Nephrol 2:328, 1991
  12. Held PJ, Pauly MV, Diamond L: Survival analyses of patients undergoing dialysis. JAMA 257:645–650, 1987 | Article | PubMed | ChemPort |
  13. Cox D: Regression models and life tables. J Roy Stat Soc 34:187–201, 1972 | ISI |
  14. Nelson CB, Port FK, Wolfe RA, Guire KE: Comparison of CAPD and hemodialysis patient survival with evaluation of trends during the 1980s. J Am Soc Nephrol 3:1147–1155, 1992 | PubMed | ISI | ChemPort |
  15. Cowie CC, Port FK, Wolfe RA, Savage PJ, Moll PP, Hawthorne VM: Disparity in incidence of diabetic end-stage renal disease by race and diabetic type. N Engl J Med 321:1074–1079, 1989 | PubMed | ISI | ChemPort |
  16. Lysaght MJ, Vonesh EF, Gotch F, Ibels L, Keen M, Lindholm B, Nolph KD, Pollock CA, Prowant B, Farrell PC: The influence of dialysis treatment modality on the decline of remaining renal function. Trans ASAIO 37:598–604, 1991
  17. Held PJ, Levin NW, Bovbjerg RR, Pauly MV, Diamond LH: Mortality and duration of hemodialysis treatment. JAMA 265:871–875, 1991 | Article | PubMed | ISI | ChemPort |

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