TY - JOUR
T1 - Comparing Patient Survival of Home Hemodialysis and Peritoneal Dialysis Patients
AU - Choi, Soo Jeong
AU - Obi, Yoshitsugu
AU - Ko, Gang Jee
AU - You, Amy S.
AU - Eriguchi, Rieko
AU - Wang, Mengjing
AU - Rhee, Connie M.
AU - Kalantar-Zadeh, Kamyar
N1 - Funding Information:
The work in this manuscript was performed with the support of the National Institute of Diabetes, Digestive and Kidney Disease of the National Institute of Health research grants R01-DK95668 (K.K.-Z.), K24-DK091419 (K.K.-Z.), R01-DK078106 (K.K.-Z.). K.K.-Z. is supported by philanthropic grants from Mr. Harold Simmons, Mr. Louis Chang, Dr. Joseph Lee and AVEO.
Publisher Copyright:
© 2020 S. Karger AG, Basel.
PY - 2020/3/1
Y1 - 2020/3/1
N2 - Background: It is not clear whether peritoneal dialysis (PD) and home hemodialysis (HHD) have similar outcomes, and little is known about how mortality associated with HHD versus PD differs according to the duration of dialysis. Methods: We examined a national cohort of incident end-stage renal disease patients that was comprised of 1,993 and 16,514 patients transitioning to HHD and PD, respectively, from 2007 to 2011. The HHD patients were matched with PD patients using propensity score (PS). Demographics, comorbidities, duration of dialysis, and body mass index were adjusted for in logistic regression models using PS matching. We matched 1,915 HHD patients with 1,915 PD patients based on the PS. The patients were categorized by their vintage (duration of dialysis) at the time of the transition to HHD or PD (<3, 3 to <12, and ≥12 months). Results: In the matched cohort, 237 and 359 deaths occurred in the HHD and PD patients, respectively (cumulative incidence 9.6 vs. 12.9/100 patient-years, p < 0.001). PD patients who transitioned within 12 months of starting dialysis had similar mortality risks, while PD patients who transitioned >12 months after starting dialysis had an 83% higher risk for mortality (hazard ratio 1.83; 95% CI 1.33-2.52). Conclusions: Whereas there was no meaningful survival difference in the first 12 months between HHD and PD, patients who transitioned to PD after 12 months of dialysis had worse survival than their HHD counterparts. Additional studies are warranted to investigate clinical implications of these differences.
AB - Background: It is not clear whether peritoneal dialysis (PD) and home hemodialysis (HHD) have similar outcomes, and little is known about how mortality associated with HHD versus PD differs according to the duration of dialysis. Methods: We examined a national cohort of incident end-stage renal disease patients that was comprised of 1,993 and 16,514 patients transitioning to HHD and PD, respectively, from 2007 to 2011. The HHD patients were matched with PD patients using propensity score (PS). Demographics, comorbidities, duration of dialysis, and body mass index were adjusted for in logistic regression models using PS matching. We matched 1,915 HHD patients with 1,915 PD patients based on the PS. The patients were categorized by their vintage (duration of dialysis) at the time of the transition to HHD or PD (<3, 3 to <12, and ≥12 months). Results: In the matched cohort, 237 and 359 deaths occurred in the HHD and PD patients, respectively (cumulative incidence 9.6 vs. 12.9/100 patient-years, p < 0.001). PD patients who transitioned within 12 months of starting dialysis had similar mortality risks, while PD patients who transitioned >12 months after starting dialysis had an 83% higher risk for mortality (hazard ratio 1.83; 95% CI 1.33-2.52). Conclusions: Whereas there was no meaningful survival difference in the first 12 months between HHD and PD, patients who transitioned to PD after 12 months of dialysis had worse survival than their HHD counterparts. Additional studies are warranted to investigate clinical implications of these differences.
KW - Home dialysis
KW - Home hemodialysis
KW - Peritoneal dialysis
UR - http://www.scopus.com/inward/record.url?scp=85079001201&partnerID=8YFLogxK
U2 - 10.1159/000504691
DO - 10.1159/000504691
M3 - Article
C2 - 31991403
AN - SCOPUS:85079001201
VL - 51
SP - 192
EP - 200
JO - American Journal of Nephrology
JF - American Journal of Nephrology
SN - 0250-8095
IS - 3
ER -