Similar survival rates seen for patients on peritoneal dialysis vs hemodialysis
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Research conducted in Ireland found that, for patients with ESKD, treatment with either peritoneal dialysis or in-center hemodialysis conferred equal survival benefits.
In a press release regarding the study, primary author Mohamed E. Elsayed, MBBS, MSc, MRCPI, of the University of Limerick, said prior investigations into survival rates between the two treatments have reached conflicting conclusions due to differences between which patients are selected for PD vs. hemodialysis, as well as varying practice patterns across countries. He continued, while randomized controlled clinical trials would be the “ideal method” for comparing survival, these are not always feasible. “The next best method,” he said, “is to use an approach that carefully considers the differences between PD and [hemodialysis] HD and conduct comparisons using what is called a propensity-score matched approach. Such a comparison allows us to take into account baseline differences between the patient groups.”
This systematic literature review, which included 17 cohort studies that comprised of 113,578 patients on dialysis, determined the overall pooled HR of death for PD vs. hemodialysis was 1.06, suggesting similar survival rates between the two treatments.
In addition, while researchers observed variation by country, meta-analyses of studies from the same geographical region revealed “equivalent” mortality risks (HRs of 1.04, 1.14 and 0.98 for European, Asian and American cohorts, respectively). The mortality risk was also similar between the treatments for patients with (HR = 1.09) and those without diabetes (HR = 0.99).
“There has been huge debate on this issue, as they are very different treatments for kidney failure,” Austin G. Stack, MBBCh, MD, MSc, foundation chair of medicine and lead investigator for the Kidney Research Consortium at the University of Limerick, said in the release. “Defining whether one treatment confers a survival advantage over another for patients who develop kidney failure is of utmost importance. We have shown in this study that the life expectancy was virtually identical on either of these therapies. This is hugely important as it means that patients have a choice.”
He added that because many studies have shown PD improves quality of life and is more cost-effective, the treatment “should be encouraged as a first-line therapy for many patients with approaching kidney failure.” – by Melissa J. Webb
Disclosures: The authors report no relevant financial disclosures.
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