Outcomes in peritoneal dialysis and haemodialysis - a comparative assessment of survival and quality of life

Ever since the introduction of peritoneal dialysis (PD) as a therapy for ma naging patients with end-stage renal disease, there has been considerable d ebate about how it compares with outcomes on haemodialysis (HD) especially in terms of survival and quality of life. Whilst earlier results in the 198 0s were certainly not comparable, data now emerging show that survival on P D is equivalent to that on HD. Recent registry data from the Canadian Organ Replacement Register show that survival of patients on PD is equivalent to that on HD and may well be better in the first few years of therapy. There have been numerous quality of life studies in patients on PD and HD. Healt h-related quality of life has been assessed using health profile measuremen ts (both generic and disease-specific instruments) or preference-based meas urements. The former approach has been used to analyse 14 different compara tive studies. These studies suggest that patients on home HD and CAPD show better quality of life than patients on centre HD. Only a few studies found statistical differences between groups, and, only in seven studies were re sults adjusted for patient differences. There is a need for longitudinal st udies with more accurate information on health. Similar data are available for preference-based measurements and studies. Overall, the analysis sugges ts that PD and HD are equivalent therapies. On this basis, it is hard to ex plain the wide variation seen in the use of the two therapies.