Han Seung Seok, Park Jae Yoon, Kang Soohee, Kim Kyoung Hoon, Ryu Dong-Ryeol, Kim Hyunwook, Joo Kwon Wook, Lim Chun Soo, Kim Yon Su, Kim Dong Ki
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea;
Medical Research Collaborating Center and.
Clin J Am Soc Nephrol. 2015 Jun 5;10(6):983-93. doi: 10.2215/CJN.05160514. Epub 2015 May 4.
Identifying the appropriate choice between hemodialysis (HD) and peritoneal dialysis (PD) is an unresolved issue in elderly patients with ESRD, who are at high risk for death but have a low chance of receiving kidney transplantation.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data on 13,065 incident dialysis Korean patients (age≥65 years) receiving HD (n=10,675) or PD (n=2390) were obtained from the Korean Health Insurance dataset. Multiple statistical approaches, including the multivariate Cox model, were used to compare mortality between Korean patients receiving PD and those receiving HD. Subsequently, meta-analysis of previous comparison studies (published since the year 2000; population-based studies) and the Korean dataset was performed.
During a mean duration of 1.8±1.3 years (maximum of 5 years), the Korean PD group had a higher mortality rate than the Korean HD group (hazard ratio [HR], 1.20 [95% confidence interval (95% CI), 1.13 to 1.28]; P<0.001 by multivariate Cox model). The discrepancy between the two modalities was greater in the presence of certain conditions, such as diabetes mellitus or longer dialysis duration. In the meta-analysis, 15 studies involving >631,421 elderly patients were reviewed. Compared with HD, the pooled HR with PD was 1.10 (95% CI, 1.01 to 1.20). When the meta-analysis was stratified by confounding factors, the survival benefit from HD was particularly strong in subgroups that had diabetes mellitus, had long dialysis duration (>1 year), or contained cohorts starting dialysis in the 1990s.
A meta-analysis that included results in Korean patients suggests a higher risk for death in elderly patients receiving PD than in those receiving HD.
对于终末期肾病（ESRD）老年患者而言，在血液透析（HD）和腹膜透析（PD）之间做出合适选择是一个尚未解决的问题，这类患者死亡风险高，但接受肾移植的机会低。
设计、地点、参与者与测量：从韩国健康保险数据集获取了13065例接受HD（n = 10675）或PD（n = 2390）的韩国新发透析患者（年龄≥65岁）的数据。采用多种统计方法，包括多变量Cox模型，比较接受PD和HD的韩国患者的死亡率。随后，对之前的比较研究（2000年以来发表的基于人群的研究）和韩国数据集进行了荟萃分析。
在平均1.8±1.3年（最长5年）的时间里，韩国PD组的死亡率高于韩国HD组（风险比[HR]，1.20[95%置信区间（95%CI），1.13至1.28]；多变量Cox模型P<0.001）。在存在某些情况时，如糖尿病或透析时间较长，两种透析方式之间的差异更大。在荟萃分析中，对15项涉及超过631421例老年患者的研究进行了综述。与HD相比，PD的合并HR为1.10（95%CI，1.01至1.20）。当按混杂因素对荟萃分析进行分层时，HD的生存获益在患有糖尿病、透析时间长（>1年）或包含20世纪90年代开始透析队列的亚组中尤为显著。
一项纳入韩国患者结果的荟萃分析表明，接受PD的老年患者比接受HD的患者死亡风险更高。
