Survival and development of cardiovascular disease by modality of treatment in patients with end-stage renal disease

Patients undergoing dialysis are at high risk for cardiovascular disease (C VD). The aim of this study was to evaluate the influence of hemodialysis (H D) versus peritoneal dialysis (PD) on survival and the risk of developing d e novo CVD. Of the 4191 patients with end-stage renal disease (ESRD) who st arted renal replacement treatment (RRT) in Lombardy between 1994 and 1997, 4064 (who were on dialysis 30 d after the start of RRT) were considered for survival analysis: 2772 were on HD (mean age 60.9 yr; 21.2% diabetic) and 1292 on PD (mean age 63.6 yr; 16% diabetic). The 3120 patients who were fre e of CVD at the start of RRT were included in the analysis of the risk of d eveloping de novo CVD. HD and PD were compared by use of a Cox-regression p roportional hazard model, stratified by diabetic status; the explanatory co variates were age and gender. The death rate was 13.3 per 100 patient-years (13.0 on HD and 13.9 on PD); 197 (6.3%) of the 3120 patients included in t he CVD analysis developed de novo, CVD (128 on HD and 69 on PD). After adju stment for age, gender, and established CVD and stratification by diabetic status, there was no significant between-treatment difference in 4-yr survi val (relative risk [RR], 0.91; 95% confidence interval [CI], 0.79 to 1.06). The risk of de novo CVD did not differ significantly by treatment modality (RR, 1.06; 95% Cl, 0.79 to 1.43). The risk of mortality and de novo CVD fo r new patients with ESRD assigned to HD or PD was similar in Lombardy in th e period 1994 through 1997.