Mehrotra Rajnish, Chiu Yi-Wen, Kalantar-Zadeh Kamyar, Bargman Joanne, Vonesh Edward
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90502, USA.
Arch Intern Med. 2011 Jan 24;171(2):110-8. doi: 10.1001/archinternmed.2010.352. Epub 2010 Sep 27.
The annual payer costs for patients treated with peritoneal dialysis (PD) are lower than with hemodialysis (HD), but in 2007, only 7% of dialysis patients in the United States were treated with PD. Since 1996, there has been no change in the first-year mortality of HD patients, but both short- and long-term outcomes of PD patients have improved.
Data from the US Renal Data System were examined for secular trends in survival among patients treated with HD and PD on day 90 of end-stage renal disease (HD, 620 020 patients; PD, 64 406 patients) in three 3-year cohorts (1996-1998, 1999-2001, and 2002-2004) for up to 5 years of follow-up using a nonproportional hazards marginal structural model with inverse probability of treatment and censoring weighting.
There was a progressive attenuation in the higher risk for death seen in patients treated with PD in earlier cohorts; for the 2002-2004 cohort, there was no significant difference in the risk of death for HD and PD patients through 5 years of follow-up. The median life expectancy of HD and PD patients was 38.4 and 36.6 months, respectively. Analyses in 8 subgroups based on age (<65 and ≥65 years), diabetic status, and baseline comorbidity (none and ≥1) showed greater improvement in survival among patients treated with PD relative to HD at all follow-up periods.
In the most recent cohorts, patients who began treatment with HD or PD have similar outcomes.
接受腹膜透析（PD）治疗的患者每年支付方成本低于接受血液透析（HD）的患者，但在2007年，美国仅7%的透析患者接受PD治疗。自1996年以来，HD患者的首年死亡率没有变化，但PD患者的短期和长期结局均有所改善。
利用美国肾脏数据系统的数据，采用非比例风险边际结构模型并结合治疗逆概率和删失加权，对三个3年队列（1996 - 1998年、1999 - 2001年和2002 - 2004年）中终末期肾病第90天接受HD和PD治疗的患者（HD组620020例患者；PD组64406例患者）的生存长期趋势进行了长达5年的随访研究。
在早期队列中接受PD治疗的患者较高的死亡风险呈逐渐减弱趋势；对于2002 - 2004年队列，在长达5年的随访中，HD和PD患者的死亡风险无显著差异。HD和PD患者的中位预期寿命分别为38.4个月和36.6个月。基于年龄（< 65岁和≥65岁）、糖尿病状态和基线合并症（无和≥1种）的8个亚组分析显示，在所有随访期内，PD治疗患者相对于HD治疗患者的生存改善更大。
在最近的队列中，开始接受HD或PD治疗的患者结局相似。
