Planned Initiation of Hemodialysis Alleviates the Survival Disadvantage of Hemodialysis Over Peritoneal Dialysis

摘要

BACKGROUND: Since the discovery of initial survival disadvantage of hemodialysis (HD) over peritoneal dialysis (PD), selection bias has been questioned when making this comparison. To minimize the bias, patients with planned initiation of HD have previously been chosen for comparison, but the results were inconclusive. Here, with a different definition for planned initiation, we tested the hypothesis that the dialysis modality had no effect on the one-year mortality rate in incident dialysis patients. METHODS: A total of 45,825 incident dialysis patients with maintenance dialysis for more than 3 months in Taiwan between 2007 and 2011 were enrolled. Planned initiation of HD was defined as the initiation of HD through peripheral vascular access at an outpatient clinic (planned-HD), and the one-year mortality rate was compared between HD and PD groups in cohorts by planned initiation of HD and propensity score (PS) matching using Cox model. RESULTS: In all, 39,635, 9,184, and 6,190 incident dialysis patients were enrolled in HD, planned-HD, and PD groups, respectively. During the observation period, the death was reported for 4,453, 812, and 342 patients, respectively. HD group had a higher one-year mortality rate than PD group after either adjusting the baseline clinical characteristics (adjusted hazards ratio [HR] = 1.17, 95% confidence interval [CI] = 1.04-1.30, P = 0.007) or PS matching (HR = 1.23, 95% CI = 1.07-1.42, P = 0.005). However, this survival disadvantage disappeared when the planned-HD group was compared with the PD group after either adjusting the baseline clinical characteristics (HR = 0.96, 95% CI = 0.85-1.10, P = 0.58) or PS matching (HR = 0.99, 95% CI = 0.85-1.16, P = 0.91). CONCLUSION: The initial survival disadvantage of HD over PD can be alleviated by planned initiation of HD in the dialysis population in Taiwan.