End Stage Kidney Disease: Does Peritoneal Dialysis Offer A Survival Advantage?

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MedicalResearch.com Interview with:
Victoria A. Kumar, M.D.
Internal Medicine/Nephrology
Division of Nephrology
Department of Internal Medicine
Southern California Permanente Medical Group
Los Angeles, California, USA

Medical Research: What are the main findings of the study?

Dr. Kumar: There was over a 2 fold increase in patient survival in incident peritoneal dialysis patients in the first year on dialysis compared to propensity matched incident hemodialysis patients.  We excluded any patients who utilized a central dialysis catheter at any point during the first 90 days on hemodialysis in an effort to reduce the mortality bias associated with hemodialysis patients who start with a catheter.  All hemodialysis patients had pre-dialysis care by a nephrologist prior to starting dialysis.

The 2+ fold increase in survival among peritoneal dialysis patients resulted in a 2-3 year cumulative survival advantage for peritoneal dialysis patients, using both intent to treat and as-treated analyses.

Medical Research: Were any of the findings unexpected?

Dr. Kumar: Given that a couple of recent reports had attributed the initial 1-2 year survival advantage seen in PD patients in several large studies to the early use of central venous catheters among matched hemodialysis patients, our findings were surprising.  Other authors have attributed the initial 1-2 year survival advantage seen in other studies to lack of pre-dialysis care, but all of our study patients were managed by a nephrologist prior to starting PD/HD.

Medical Research: What should clinicians and patients take away from your report?

Dr. Kumar: The survival advantage afforded by peritoneal dialysis in the first couple years on dialysis should be emphasized when patients are in the process of choosing a dialysis modality.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Kumar: RCT comparing peritoneal dialysis to hemodialysis is probably not feasible. Future studies might address the issue of baseline residual renal function and changes in residual renal function over time when comparing survival among well matched PD/HD patients.

Citation:
Survival of propensity matched incident peritoneal and hemodialysis patients in a United States health care system
Victoria A Kumar1, Margo A Sidell2, Jason P Jones2 and Edward F Vonesh3
Kidney International advance online publication 2 July 2014; doi: 10.1038/ki.2014.224

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