Department of Public Health, Centre Paul Strauss, Strasbourg, France.
Department of Public Health, Strasbourg University Hospital, Strasbourg, France.
Nephrol Dial Transplant. 2018 Aug 1;33(8):1411-1419. doi: 10.1093/ndt/gfy007.
Previous studies comparing the outcomes in haemodialysis (HD) with those in peritoneal dialysis (PD) have yielded conflicting results.
The aim of the study was to compare the survival of planned HD versus PD patients in a cohort of adult incident patients who started renal replacement therapy (RRT) between 2006 and 2008 in the nationwide REIN registry (Réseau Epidémiologie et Information en Néphrologie). Patients who started RRT in emergency or stopped RRT within 2 months were excluded. Adjusted Cox models, propensity score matching and marginal structural models (MSMs) were used to compensate for the lack of randomization and provide causal inference from longitudinal data with time-dependent treatments and confounders including transplant censorship, modality change over time and time-varying covariates.
Among a total of 13 767 dialysis patients, 13% were on PD at initiation of RRT and 87% were on HD. The median survival times were 53.5 months or 4.45 years and 38.6 months or 3.21 years for patients starting on HD and PD, respectively. Regardless of the model used, there was a consistent advantage in terms of survival for HD patients: hazard ratio (HR) 0.76 [95% confidence interval (95% CI) 0.69-0.84] with the Cox model using propensity score; HR 0.67 (95% CI 0.62-0.73) in the Cox model with censorship for each treatment change; and HR 0.82 (95% CI 0.69-0.97) with MSMs. However, MSMs tended to reduce the survival gap between PD and HD patients.
This large cohort study using various statistical methods to minimize the bias appears to demonstrate a better survival in planned HD than in PD.
此前比较血液透析（HD）和腹膜透析（PD）治疗结果的研究得出了相互矛盾的结果。
本研究旨在比较 2006 年至 2008 年期间全国范围内 REIN 登记处（Réseau Epidémiologie et Information en Néphrologie）中开始肾脏替代治疗（RRT）的成年新发病例患者中计划进行 HD 与 PD 治疗的患者的生存率。排除急诊开始 RRT 或在 2 个月内停止 RRT 的患者。使用调整后的 Cox 模型、倾向评分匹配和边际结构模型（MSM）来补偿缺乏随机分组，并提供具有时间依赖性治疗和混杂因素（包括移植审查、随时间改变的治疗方式和时变协变量）的纵向数据的因果推断。
在总共 13767 名透析患者中，13%在开始 RRT 时接受 PD 治疗，87%接受 HD 治疗。开始 HD 和 PD 治疗的患者中位生存时间分别为 53.5 个月或 4.45 年和 38.6 个月或 3.21 年。无论使用哪种模型，HD 患者的生存优势都一致：使用倾向评分的 Cox 模型 HR 为 0.76（95%CI 0.69-0.84）；在每种治疗方法改变时都进行审查的 Cox 模型 HR 为 0.67（95%CI 0.62-0.73）；以及 MSMs 的 HR 为 0.82（95%CI 0.69-0.97）。然而，MSM 倾向于缩小 PD 和 HD 患者之间的生存差距。
本研究使用多种统计方法来最大程度地减少偏倚，结果似乎表明计划进行 HD 治疗的患者生存率优于 PD 治疗。
