Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland.
Nephrol Dial Transplant. 2013 Dec;28(12):3072-81. doi: 10.1093/ndt/gft326. Epub 2013 Sep 12.
Studies on dialysis modality and survival have shown conflicting results, mostly due to insufficient and varying control of confounding factors. Using comprehensive data on a well-defined patient cohort, we therefore investigated the association of dialysis modality with survival on chronic renal replacement therapy (RRT) and whether this association varies between subgroups of patients.
Survival analyses included all adult patients entering chronic RRT in Finland between 2000 and 2009 and used information obtained from the Finnish Registry for Kidney Diseases and the Finnish Kidney Transplant Registry. In our primary intention-to-treat (ITT) analysis, we calculated relative risk of death according to dialysis modality on Day 91 from RRT start, comparing peritoneal dialysis (PD) to haemodialysis (HD). Relative risks were adjusted for putative confounders. Interactions between treatment groups and other variables were estimated.
Of the total 4463 patients, 42% died during the 10 years of follow-up. Median survival time was 5.2 years. In unadjusted ITT analysis, relative risk of death of PD patients was 0.65 (95% CI 0.58-0.73, P < 0.001) compared with HD patients. With adjustment for 26 variables, the corresponding relative risk of death was 1.07 (95% CI 0.94-1.22, P = 0.33). When censoring at time of kidney transplantation, the result was similar with a relative risk of death of 1.09 (95% CI 0.95-1.25, P = 0.24) on PD compared with HD.
PD is associated with several factors generally related to good prognosis. After comprehensive adjustment for putative confounding factors with the ITT analysis approach, we found no significant difference in survival between PD and HD patients.
关于透析方式与生存率的研究结果相互矛盾，主要是由于混杂因素的控制不足且存在差异。因此，我们使用明确的患者队列的综合数据，调查了透析方式与慢性肾脏替代治疗（RRT）生存率的相关性，以及这种相关性在患者亚组之间是否存在差异。
生存分析包括 2000 年至 2009 年期间在芬兰接受慢性 RRT 的所有成年患者，使用芬兰肾脏病登记处和芬兰肾脏移植登记处获得的信息。在我们的主要意向治疗（ITT）分析中，我们根据 RRT 开始后第 91 天的透析方式计算了死亡的相对风险，将腹膜透析（PD）与血液透析（HD）进行比较。相对风险根据潜在混杂因素进行了调整。还估计了治疗组与其他变量之间的交互作用。
在总共 4463 名患者中，有 42%在 10 年的随访期间死亡。中位生存时间为 5.2 年。在未经调整的 ITT 分析中，PD 患者的死亡相对风险为 0.65（95%CI 0.58-0.73，P < 0.001），与 HD 患者相比。在调整 26 个变量后，相应的死亡相对风险为 1.07（95%CI 0.94-1.22，P = 0.33）。当在肾移植时进行删失时，结果相似，PD 患者的死亡相对风险为 1.09（95%CI 0.95-1.25，P = 0.24），与 HD 患者相比。
PD 与一般与良好预后相关的多个因素有关。在使用 ITT 分析方法对潜在混杂因素进行全面调整后，我们发现 PD 与 HD 患者的生存率无显著差异。
