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Hemodialysis, peritoneal hemodialysis, survival rate, Mortality
Background and Aim: In recent years, as the world faces a rising prevalence of chronic diseases, such as chronic kidney disease (CKD), there has been a growing focus on evaluating health outcomes related to different dialysis methods. This study includes examining the comparative survival outcomes between peritoneal dialysis (PD) and hemodialysis (HD).
Patients and Methods: A total of 856 hemodialysis and 286 peritoneal hemodialysis adult patients were investigated in the Department of Nephrology, Khyber Teaching Hospital, Peshawar from March 2022 to April 2023. All the patients diagnosed of end-stage renal disease successfully undergone a comprehensive modality assessment were included. Hemodialysis and peritoneal dialysis were the predictors for mortality from any causes as an outcome.
Results: A total of 1142 end-stage renal disease patients including 856 hemodialysis and 286 peritoneal hemodialysis were investigated. The overall mean age of HD and PD patients was 62.5±6.8 years and 60.4±8.56 years respectively. In general, individuals with HD (hemodialysis) exhibited advanced age and a greater prevalence of causes such as hypertension, diabetes, cerebrovascular disease, coronary artery disease, malignancy, congestive heart failure, and peripheral vascular disease. We observed a significant interaction between age and dialysis approach (P = 0.01), along with a time-dependent connection between dialysis method and survival. For the elderly population (aged <65and ≥65 years), there was no statistically notable contrast in overall mortality rates between HD and PD.
Conclusion: Hemodialysis (HD) and peritoneal dialysis (PD) show comparable mortality rates in newly initiated dialysis patients fulfilling both the treatment options. The later preferred by patients having satisfactory financial status.
2. Zhou H, Sim JJ, Bhandari SK, et al. Early mortality among peritoneal dialysis and hemodialysis patients who transitioned with an optimal outpatient start. Kidney Int Rep. 2019;4(2):275-284. doi:10.1016/j.ekir.2018.10.008.
3. Sandoval C. Association between type of dialysis and survival in patients with chronic renal disease in Colombia. Analysis with Marginal Structural Models; 2017.
4. Foster BJ, Laskin BL, Mitsnefes MM, Dahhou M, Zhang X. Changes in excess mortality from end stage renal disease in the United States from 1995 to 2013. Clin J Am Soc Nephrol. 2017;13(1):91-99.
5. Okuyama A, Shibata A, Nishimoto H. Critical points for interpreting patients’ survival rate using cancer registries: a literature review. J Epidemiol. 2017;28(2):61-66.
6. Wong B, Ravani P, Oliver MJ, Holroyd-Leduc J, Venturato L, Garg AX, Quinn RR. Comparison of patient survival between hemodialysis and peritoneal dialysis among patients eligible for both modalities. American Journal of Kidney Diseases. 2018 Mar 1;71(3):344-51.
7. Noordzij M, Krediet RT. Choice of Hemodialysis or Peritoneal Dialysis for Kidney Replacement Therapy. Evidence‐Based Nephrology. 2022 Dec 2;1:671-80.
8. Gong Y, Zhao Y, Ran L, Liu Y. Comparison Between Hemodialysis and Peritoneal Dialysis in the Risks for Disease Activity in LN-ESRD Patients: A Systematic Review and Meta-analysis. Alternative Therapies in Health & Medicine. 2022 Sep 1;28(6).
9. Kuo G, Chen JJ, Cheng YL, Fan PC, Lee CC, Chang CH. Comparison between peritoneal dialysis and hemodialysis on kidney function recovery in incident kidney failure: A nationwide cohort study. InSeminars in Dialysis 2022 May (Vol. 35, No. 3, pp. 278-286).
10. Shukri A, Mettang T, Scheckel B, Schellartz I, Simic D, Scholten N, Müller M, Stock S. Hemodialysis and Peritoneal Dialysis in Germany from a Health Economic View—A Propensity Score Matched Analysis. International journal of environmental research and public health. 2022 Oct 27;19(21):14007.
11. Noordzij M, Blake PG. Patient Survival Comparisons Between Peritoneal Dialysis and Hemodialysis. InNolph and Gokal's Textbook of Peritoneal Dialysis 2023 Mar 21 (pp. 47-62). Cham: Springer International Publishing.
12. Zazzeroni L, Pasquinellia G, Nannib E, Cremoninib V, Rubbib I. Comparison of quality of life in patients undergoing hemodialysis and peritoneal dialysis: a systematic review and meta-analysis. Kidney Blood Press Res. 2017;42:717–27.
13. van de Luijtgaarden MW, Jager KJ, Segelmark M, et al. Trends in dialysis modality choice and related patient survival in the ERA-EDTA registry over a 20-year period. Nephrol Dial Transplant. 2016;31:120–8.
14. Elsayed ME, Morris AD, Li X, Browne LD, Stack AG. Propensity score matched mortality comparisons of peritoneal and in-centre haemodialysis: systematic review and meta-analysis. Nephrol Dial Transplant. 2020; in press.
15. Levey AS, Eckardt KU, Dorman NM, et al. Nomenclature for kidney function and disease: report of a kidney disease: improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int. 2020; 97(6): 1117-1129.
16. Lee YJ, Okuda Y, Sy J, et al. Ultrafiltration rate, residual kidney function, and survival among patients treated with reduced-frequency hemodialysis. Am J Kidney Dis. 2020; 75(3): 342-350.
17. Marants R, Qirjazi E, Grant CJ, Lee TY, McIntyre CW. Renal perfusion during hemodialysis: intradialytic blood flow decline and effects of dialysate cooling. J am Soc Nephrol. 2019; 30(6): 1086-1095.
18. Park JI, Park JT, Kim YL, et al. Comparison of outcomes between the incremental and thrice-weekly initiation of hemodialysis: a propensity-matched study of a prospective cohort in Korea. Nephrol Dial Transplant. 2017; 32: 355-363.
19. Xue J, Li H, Zhou Q, Wen S, Zhou Q, Chen W. Comparison of peritoneal dialysis with hemodialysis on survival of diabetic patients with end-stage kidney disease: a meta-analysis of cohort studies. Ren Fail. 2019; 41(1): 521–31. https://doi.org/10.1080/0886022X.2019.1625788.
20. Kim HJ, Park JT, Han SH, Yoo TH, Park HC, Kang SW, et al. The pattern of choosing dialysis modality and related mortality outcomes in Korea: a national population-based study. Korean J Intern Med. 2017; 32(4): 699–710. https://doi.org/10.3904/kjim.2017.141.
21. Fan L, Yang X, Chen Q, Zhang H, Wang J, Chen M, Peng H, Ni Z, Wan J, Yang H, Li Y. Burden of kidney disease among patients with peritoneal dialysis versus conventional in-centre haemodialysis: A randomised, non-inferiority trial. Peritoneal Dialysis International. 2022 May;42(3):246-58.
22. Liu H, He Z, Hu X, Li S, Wang L, Zhao D, Lin Q, Liu X, Lu F, Zhang D. Propensity-matched comparison of mortality between peritoneal dialysis and hemodialysis in patients with type 2 diabetes. International urology and nephrology. 2022 Jun 1:1-9.
23. Garcia Sierra AM. Utilization and Costs of Home Hemodialysis, In-Center Hemodialysis, and Peritoneal Dialysis Among Patients with End-Stage Renal Disease (ESRD) in the United States.
24. do Nascimento Lima H, Nerbass FB, Lugon JR, Sesso R. Characteristics and 1-year survival of incident patients on chronic peritoneal dialysis compared with hemodialysis: a large 11-year cohort study. International Urology and Nephrology. 2023 Feb 21:1-9.
25. Xu F, Yang Y, Wu M, Zhou W, Wang D, Cui W. Patients with end‐stage renal disease and diabetes had similar survival rates whether they received hemodialysis or peritoneal dialysis. Therapeutic Apheresis and Dialysis. 2023 Feb;27(1):59-65.