The effect of dialysis modality on annual mortality: A prospective cohort study

TL;DR

This study compares hemodialysis and peritoneal dialysis in ESRD patients and finds that hemodialysis may be better for younger patients with diabetes over long-term follow-ups.

Contribution

The study introduces a novel analysis of dialysis modality effects using weighted Fine and Gray models and landmark analysis in a large prospective cohort.

Findings

No significant overall difference in mortality hazard between hemodialysis and peritoneal dialysis.

Peritoneal dialysis showed higher mortality risk in patients under 65 and those with diabetes after 4-5 years.

Landmark analysis revealed higher hazard rates for peritoneal dialysis at specific follow-up points in certain subgroups.

Abstract

Despite numerous studies on the effect of each dialysis modality on mortality, the issue remains controversial. We investigated the hazard rate of mortality in patients with incident end-stage renal disease (ESRD) concerning initial dialysis modality (hemodialysis vs. peritoneal dialysis). Using a nationwide, multicenter, prospective cohort in South Korea, we studied 2207 patients, of which 1647 (74.6%) underwent hemodialysis. We employed the weighted Fine and Gray model over the follow-up period using inverse probability of treatment and censoring weighting. Landmark analysis was used for identifying the changing effect of dialysis modality on individuals who remained event-free at each landmark point. No significant difference in hazard rate was observed overall. However, the peritoneal dialysis group had a significantly higher hazard rate than the hemodialysis group among patients under 65 years after 4- and 5- year follow-up. A similar pattern was observed among those with diabetes mellitus. Landmark analysis also showed the higher hazard rate for peritoneal dialysis at 2 years for the education-others group and at 3 years for the married group. These findings may inform dialysis modality decisions, suggesting a preference for hemodialysis in young patients with diabetes, especially for follow-ups longer than 3 years.

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