HEMODIALYSIS VERSUS PERITONEAL-DIALYSIS - A COMPARISON OF ADJUSTED MORTALITY-RATES

Although kidney transplantation is the preferred treatment method for patients with ESRD, most patients are placed on dialysis either while awaiting transplantation or as their only therapy, The question of whi ch dialytic method provides the best patient survival remains unresolv ed, Survival analyses comparing hemodialysis and continuous ambulatory peritoneal dialysis/continuous cyclic peritoneal dialysis (CAPD/CCPD) , a newer and less costly dialytic modality, have yielded conflicting results, Using data obtained from the Canadian Organ Replacement Regis ter, we compared mortality rates between hemodialysis and CAPD/CCPD am ong 11,970 ESRD patients who initiated treatment between 1990 and 1994 and were followed-up for a maximum of 5 years, Factors controlled for include age, primary renal diagnosis, center size, and predialysis co morbid conditions, The mortality rate ratio (RR) for CAPD/CCPD relativ e to hemodialysis, as estimated by Poisson regression, was 0.73 (95% c onfidence interval: 0.68 to 0.78), No such relationship was found when an intent-to-treat Cox regression model was fit, Decreased covariable -adjusted mortality for CAPD/CCPD held within all subgroups defined by age and diabetes status, although the RRs increased with age and diab etes prevalence, The increased mortality on hemodialysis compared with CAPD/CCPD was concentrated in the first 2 years of follow-up, Althoug h continuous peritoneal dialysis was associated with significantly low er mortality rates relative to hemodialysis after adjusting for known prognostic factors, the potential impact of unmeasured patient charact eristics must be considered, Notwithstanding, we present evidence that CAPD/CCPD, a newer and less costly method of renal replacement therap y, is not associated with increased mortality rates relative to hemodi alysis, (C) 1997 by the National Kidney Foundation, Inc.