Comparison Of Survival In Patients On Hemodialysis And Peritoneal Dialysis

Objective:To know basic characteristics of hemodialysis and peritoneal dialysis population in general hospital in china.Evaluating and comparing survival in patients on hemodialysis and peritoneal dialysis.And to explore the main risk factors affecting survival of dialysis.Methods:The demographic and clinical data of incident patients stating hemodialysis and peritoneal dialysis in Zhong Shan Hospital,Fudan University between 1 January 2005 and 31 December 2008 was retrospectively analysised.All patients were followed up through 31 March 2009.survival analysis was performed using Kaplan-Meier method, log-rank test and Cox regression model.The method of intention to treat analysis and as treated analysis were both performed in this study.Results:1.A total of 460 patients were enrolled.247 patients accepted the therapy of hemodialysis initially and others accepted the therapy of peritoneal dialysis.There was no significant difference of age,BMI,the history of renal insufficiency,eGFR, albumin,MAP,urine volume,cerebrovascular accident,cardiovascular accident, CHF and CCI between patients on hemodialysis and peritoneal dialysis at the beginning of dialysis(P＞0.05).2.Results of intention to treat analysis:Kaplan-Meier survival curve revealed that overall mortality rates were significantly lower among those being treated with HD initially(P＜0.05,log-rank test).But this risk was not constant over time. Mortality was similar in the first 1 year(P=0.14,log-rank test).In the period beyond 1 year,there was a significantly higher mortality among those treated with PD initially.When adjusted by age and DM,survival was better on HD(P＜0.05, log-rank test)in the group of nondiabetic patients old than 65 years.Although survival was slightly better on PD in the group of nondiabetic patients younger than 65 years,there was no significant difference of survival between HD and PD patients(P＞0.05,log-rank test).The multivariate Cox regression model indicated that there was no significant difference of survival between HD and PD patients when adjusted by case-mix differences(HR(HD:PD)=0.778,95%CI (0.483-1.254),P＜0.303) and age(HR=1.051,95%CI 1.030-1.073,P＜0.01),cerebrovascular accident(HR=2.032,95%CI 1.125-3.670,P＜0.05),CCI≥5 (HR=2.592,95%CI 1.230-5.465,P＜0.05),PAB(HR=0.022,95%CI 0.001-0.768,P＜0.05) were the main risk factors to survival of dialysis.3.Results of as treated analysis was constant with those of intention to treat analysis except for PAB of which was no longer the main risk factors to survival of dialysis in as treated analysis.Conclusion:1.Survival was similar between HD and PD patients in the first 1 year of dialysis. In the period beyond 1 year,there maybe a significantly higher mortality among those treated with PD.Survival was better on HD in nondiabetic patients older than 65 years.2.Age,cerebrovascular accident and CCI≥5 were the main risk factors to survival of dialysis.