Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.
J Nephrol. 2013 Mar-Apr;26(2):331-41. doi: 10.5301/jn.5000149. Epub 2012 Mar 30.
The question of which modality, either peritoneal dialysis (PD) or hemodialysis (HD), confers the survival advantage for incident ESRD patients with pre-existing cardiovascular disease (CVD) remains unanswered.
Data used in this study were extracted from the National Health Insurance Research Database in Taiwan. From 1997 to 2007, incident ESRD patients who underwent dialysis longer than three months were selected. The established dialysis modality at day 90 was used to analyze the impact of dialysis modality on survival. For each PD patient indentified, five HD patients matched for age, sex, and year in which the patients received their first dialysis treatment were randomly selected. Finally, a total of 35 664 patients including 29 720 HD patients and 5944 PD patients were selected. The primary outcome was death after commencing dialysis.
For diabetic ESRD patients with or without coronary artery disease (CAD) or congestive heart failure (CHF), patients receiving PD had inferior survival compared with those receiving HD (P<.001, adjusted HR=1.34 to 1.43). For nondiabetic patients with CAD or CHF, patients receiving PD also had inferior survival compared with those receiving HD (adjusted HR=1.30, CI: 1.08 to 1.57; adjusted HR=1.31, CI: 1.11 to 1.55). For nondiabetic ESRD patients without CAD or CHF, there was no statistically significant difference in survival between PD and HD (adjusted HR=1.00, CI: 0.92 to 1.09; adjusted HR=0.98, CI: 0.90 to 1.07).
PD was associated with poorer survival among ESRD patients with CVD or diabetes mellitus compared with HD.
对于患有心血管疾病（CVD）的新发生终末期肾病（ESRD）患者，哪种治疗方式，腹膜透析（PD）或血液透析（HD），具有生存优势，这个问题仍未得到解答。
本研究使用的数据来自中国台湾的全民健康保险研究数据库。从 1997 年至 2007 年，选择了接受透析治疗时间超过三个月的新发生 ESRD 患者。使用第 90 天的建立透析方式来分析透析方式对生存的影响。对于确定的每个 PD 患者，随机选择 5 名年龄、性别和开始透析治疗年份匹配的 HD 患者。最终，共选择了 35664 名患者，包括 29720 名 HD 患者和 5944 名 PD 患者。主要结局是开始透析后的死亡。
对于患有或不患有冠状动脉疾病（CAD）或充血性心力衰竭（CHF）的糖尿病 ESRD 患者，与接受 HD 的患者相比，接受 PD 的患者生存情况较差（P<.001，调整后的 HR=1.34 至 1.43）。对于患有 CAD 或 CHF 的非糖尿病患者，接受 PD 的患者与接受 HD 的患者相比，生存情况也较差（调整后的 HR=1.30，CI：1.08 至 1.57；调整后的 HR=1.31，CI：1.11 至 1.55）。对于没有 CAD 或 CHF 的非糖尿病 ESRD 患者，PD 和 HD 之间的生存情况没有统计学差异（调整后的 HR=1.00，CI：0.92 至 1.09；调整后的 HR=0.98，CI：0.90 至 1.07）。
与 HD 相比，PD 与 CVD 或糖尿病患者的 ESRD 患者的生存情况较差相关。
