# Hemodialysis versus peritoneal dialysis in elderly ESRD patients: a retrospective cohort study on survival and the role of comorbidities

## TL;DR

This study compares hemodialysis and peritoneal dialysis in elderly kidney failure patients, finding that hemodialysis may improve survival, especially for those with heart failure or diabetes.

## Contribution

The study identifies specific comorbidity-based survival advantages of hemodialysis over peritoneal dialysis in elderly ESRD patients.

## Key findings

- Hemodialysis was associated with lower all-cause mortality compared to peritoneal dialysis in elderly ESRD patients.
- Hemodialysis showed a significant survival benefit for patients with heart failure or diabetes.
- Peritoneal dialysis was linked to fewer hemorrhagic deaths, suggesting it may be safer for patients with cerebrovascular disease.

## Abstract

To compare survival differences between hemodialysis (HD) and peritoneal dialysis (PD) in elderly patients (≥ 60 years old) with end-stage renal disease (ESRD), and to analyze the impact of key comorbidities (heart failure, cerebrovascular disease, diabetes) on prognosis and causes of death, to inform dialysis modality selection.

This single-center retrospective cohort study enrolled 377 elderly ESRD patients (216 HD, 161 PD) who initiated dialysis between 2012 and 2017, with follow-up until 2024. Survival rates were compared using the Kaplan-Meier method. The Cox proportional hazards model was used to analyze risk factors for all-cause mortality, and the competing risks model was employed to assess risks for specific causes of death. Subgroup analyses were performed for patients with heart failure, cerebrovascular disease, and diabetes.

In the overall population, the HD group had a significantly lower risk of all-cause mortality than the PD group (adjusted HR = 0.599, 95% CI: 0.45–0.79). Subgroup analyses revealed that the survival advantage of HD was particularly pronounced in patients with concomitant heart failure (adjusted HR = 0.422, 95% CI: 0.25–0.70) or diabetes (adjusted HR = 0.687, 95% CI: 0.48–0.98). Notably, HD was identified as an independent risk factor for hemorrhagic death (sHR = 8.773, 95% CI: 1.03–74.42), with the PD group demonstrating a markedly lower cumulative incidence of such events.

For elderly ESRD patients, dialysis modality selection should be individualized based on comorbidities. HD may be associated with a survival benefit and might be prioritized for patients with concomitant heart failure or diabetes. PD may be considered a safer option, particularly for patients with cerebrovascular disease who are at high risk of bleeding.

Not applicable.

The online version contains supplementary material available at 10.1186/s12882-026-04783-7.