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| COMPARISON OF CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS AND HEMODIALYSIS PATIENT SURVIVAL WITH EVALUATION OF TRENDS DURING THE 1980S |
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| Author(s): NELSON CB, PORT FK, WOLFE RA, GUIRE KE |
| Source: JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY Volume: 3 Issue: 5 Pages: 1147-1155 Published: NOV 1992 |
| Times Cited: 67 References: 40 |
| Abstract: To evaluate the mortality of continuous ambulatory peritoneal dialysis (CAPD) patients relative to hemodialysis (HD) patients, all Michigan residents 20 to 59 yr of age who initiated therapy for ESRD during the 1980s (N= 4,288) were studied. The study population was stratified by primary renal diagnosis (glomerulonephritis, hypertension, diabetes, other), and analyses were conducted within each group by Cox proportional hazards methods controlling for age, race, sex, and year in which chronic dialysis was initiated. Intent-to-treat (ITT) and treatment history (RxHx) censoring criteria were used. For patients with hypertension or other reported causes of ESRD, there was no significant difference in CAPD and HD patient mortality (relative risk (RR) = 0.99 and 1.05, respectively). In the ITT analysis, both glomerulonephritic (RR = 0.73; P = 0.10) and diabetic patients using CAPD experienced-mortality rates lower than their HD counterparts. Among diabetics, this difference ranged from a RR of 0.40 to 0.70, being lowest for younger diabetics and statistically significant (P less-than-or-equal-to 0.05) for ages 20 to 52 yr. Evaluation of mortality trends showed a significant (P < 0.0 1) decrease in diabetic CAPD mortality rates during the decade, whereas diabetic HD mortality rates increased P = 0.06). Among diabetics, men had higher mortality rates than women (ITT - RxHx; RR = 1.22 to 1.27; P < 0.001) and white patients had higher mortality rates than black patients (ITT-RxHx, RR = 1.34 to 1.44; P < 0.001). Differences in mortality by sex and race were not found among nondiabetics, but mortality did increase significantly with age in all groups. For nondiabetics, results were unchanged when RxHx censoring criteria were used, whereas for diabetics, mortality rates for CAPD and HD users became more similar (P > 0.10). Median survival of diabetic CAPD and HD patients differed by 12 months (HD, 24 months versus CAPD, 36 months) in the ITT model. The lower mortality rates of young diabetic and glomerulonephritic patients using CAPD may be due to differential distribution of comorbid conditions and bias in the selection of a dialytic modality. |
| Document Type: Article |
| Language: English |
Addresses:
1. MICHIGAN KIDNEY REGISTRY, 315 W HURON, SUITE 340, ANN ARBOR, MI 48103 USA
2. UNIV MICHIGAN, SCH PUBL HLTH, DEPT EPIDEMIOL, ANN ARBOR, MI 48109 USA
3. UNIV MICHIGAN, SCH PUBL HLTH, DEPT BIOSTAT, ANN ARBOR, MI 48109 USA
4. UNIV MICHIGAN, SCH MED, DEPT INTERNAL MED, ANN ARBOR, MI 48104 USA |
| Publisher: WILLIAMS & WILKINS, 351 WEST CAMDEN ST, BALTIMORE, MD 21201-2436 |
| Subject Category: Urology & Nephrology |
| IDS Number: KB972 |
| ISSN: 1046-6673 |
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