Patient survival among incident peritoneal dialysis and hemodialysis patients in an urban setting

We retrospectively evaluated 432 patients (336 black; 78%; and 96 white; 22 %) incident to our peritoneal dialysis (PD; 195 patients; 45%) and hemodial ysis (HD; 237 patients; 55%) programs from January 1987 to December 1997 wh o survived their first 90 days of dialysis therapy. Black patients comprise d 70% of the PD and 84% of the HD patients (P < 0.01). PD patients were mor e often men and younger than HD patients and less often had diabetes (40% v ersus 56% of HD patients; P < 0.01) and cardiac disease (44% versus 58% of HD patients; P < 0.01) than HD patients. Adjusting for baseline clinical an d comorbid features, patient survival was determined by Cox regression anal ysis. Survival was better on PD therapy overall (relative risk [RR] for PD versus HD, 0.80; 1-, 2-, and 8-year survival rates, 90%, 77%, and 43% on PD versus 88%, 72%, and 35% on HD, respectively; P = 0.21) and among black pa tients (RR for PD versus HD, 0.69; 1-, 2-, and 5-year survival rates, 92%, 80%, and 52% on PD versus 88%, 74%, and 40% on HD, respectively; P = 0.09), but these were not statistically significant. The RR for PD versus HD was 1.08 for white patients (1-, 2-, and 5-year survival rates, 82%, 61%, and 2 3% for PD versus 82%, 62%, and 24% for HD; P = 0.79). Significant predictor s of mortality were race (RR for whites versus blacks, 1.51), age (RR, 1.03 ), cardiac disease (RR, 1.57), baseline albumin level (RR, 0.60), baseline serum creatinine level (RR, 0.91), baseline blood urea nitrogen level (RR, 1.01), and baseline weight (RR, 0.98). In conclusion, patient survival on d ialysis therapy is significantly better for black patients and for patients entering dialysis with signs of adequate nutrition (increased weight and c reatinine and albumin levels) and without evidence of cardiac disease. In a n urban dialysis program, we find that adjusted patient survival on PD equa ls or is better than that on HD therapy, particularly among black patients, making PD a viable alternative to HD in our patient population. (C) 2000 b y the National Kidney Foundation, Inc.