Morbidity outcomes by ESRD treatment modality

Practice patterns in both peritoneal dialysis and hemodialysis have changed dramatically in recent years. Most recent clinical studies comparing perit oneal dialysis and hemodialysis have used mortality as outcome. Surprisingl y few studies have compared hospitalization or other measures of morbidity. Several methodological issues cloud comparisons, including non-constant ha zards ratios, a much higher rate of transfer from peritoneal dialysis to he modialysis than vice versa, and the very real possibility of differences in ascertainment of morbidity data, such as hospitalization. We examined a pr ospective, multicenter cohort of 822 consecutive patients starting dialysis therapy. Comorbidity assessment was extensive. Adjusted mortality estimate s were similar in hemodialysis and peritoneal dialysis patients. Conclusion s about hospitalization rates were heavily dependent on 2 factors: whether comparisons began at inception of dialysis therapy or at 3 months, and whet her intention-to-treat or treatment-received analysis was used. Taken toget her, when early treatment switches were accounted for, peritoneal dialysis was associated with higher hospitalization rates. We also examined the reas on for hospitalization. A differential hospitalization pattern was observed , with peritoneal dialysis patients showing higher rates for vascular admis sions and admissions related to dialysis technique, and lower rates of non- technique-related infections. Comparison of morbidity is an important, unde rstudied, asp ect of hemodialysis/peritoneal dialysis comparisons. Methodol ogical issues can have a large impact on morbidity comparisons. Potentially large morbidity differences may exist without apparent differences in mort ality.