Chronic Disease Research Group, Minneapolis, MN 55404, USA.
J Am Soc Nephrol. 2010 Mar;21(3):499-506. doi: 10.1681/ASN.2009060635. Epub 2010 Feb 4.
Contemporary comparisons of mortality in matched hemodialysis and peritoneal dialysis patients are lacking. We aimed to compare survival of incident hemodialysis and peritoneal dialysis patients by intention-to-treat analysis in a matched-pair cohort and in subsets defined by age, cardiovascular disease, and diabetes. We matched 6337 patient pairs from a retrospective cohort of 98,875 adults who initiated dialysis in 2003 in the United States. In the primary intention-to-treat analysis of survival from day 0, cumulative survival was higher for peritoneal dialysis patients than for hemodialysis patients (hazard ratio 0.92; 95% CI 0.86 to 1.00, P = 0.04). Cumulative survival probabilities for peritoneal dialysis versus hemodialysis were 85.8% versus 80.7% (P < 0.01), 71.1% versus 68.0% (P < 0.01), 58.1% versus 56.7% (P = 0.25), and 48.4% versus 47.3% (P = 0.50) at 12, 24, 36, and 48 months, respectively. Peritoneal dialysis was associated with improved survival compared with hemodialysis among subgroups with age <65 years, no cardiovascular disease, and no diabetes. In a sensitivity analysis of survival from 90 days after initiation, we did not detect a difference in survival between modalities overall (hazard ratio 1.05; 95% CI 0.96 to 1.16), but hemodialysis was associated with improved survival among subgroups with cardiovascular disease and diabetes. In conclusion, despite hazard ratio heterogeneity across patient subgroups and nonconstant hazard ratios during the follow-up period, the overall intention-to-treat mortality risk after dialysis initiation was 8% lower for peritoneal dialysis than for matched hemodialysis patients. These data suggest that increased use of peritoneal dialysis may benefit incident ESRD patients.
目前缺乏血液透析和腹膜透析患者死亡率的当代比较。我们旨在通过匹配对队列和按年龄、心血管疾病和糖尿病定义的亚组进行意向治疗分析，比较新开始血液透析和腹膜透析患者的生存情况。我们匹配了 2003 年在美国开始透析的 98875 名成年人回顾性队列中的 6337 对患者。在生存意向治疗分析的主要分析中，从第 0 天开始，腹膜透析患者的累积生存率高于血液透析患者（风险比 0.92；95%置信区间 0.86 至 1.00，P = 0.04）。腹膜透析与血液透析的累积生存率分别为 85.8%和 80.7%（P < 0.01）、71.1%和 68.0%（P < 0.01）、58.1%和 56.7%（P = 0.25）和 48.4%和 47.3%（P = 0.50），分别在 12、24、36 和 48 个月时。在年龄<65 岁、无心血管疾病和无糖尿病的亚组中，腹膜透析与血液透析相比，生存情况得到改善。在起始后 90 天生存的敏感性分析中，我们并未发现总体上两种方式之间的生存差异（风险比 1.05；95%置信区间 0.96 至 1.16），但在有心血管疾病和糖尿病的亚组中，血液透析与生存情况改善相关。总之，尽管在患者亚组中存在风险比异质性且在随访期间风险比不恒定，但与匹配的血液透析患者相比，腹膜透析患者在透析开始后的总体意向治疗死亡率低 8%。这些数据表明，增加腹膜透析的使用可能会使新发生的终末期肾病患者受益。
