Home About us Current issue Back issues Submission Instructions Advertise Contact Login   

Search Article 
  
Advanced search 
 
Saudi Journal of Kidney Diseases and Transplantation
Users online: 2299 Home Bookmark this page Print this page Email this page Small font sizeDefault font size Increase font size 
 

Table of Contents   
RENAL DATA FROM ASIA - AFRICA  
Year : 2015  |  Volume : 26  |  Issue : 2  |  Page : 392-397
Comparison of survival in patients with end-stage renal disease receiving hemodialysis versus peritoneal dialysis


1 Department of Internal Medicine, Jundishapour University of Medical Sciences, Ahvaz, Iran
2 Department of Pediatric, Jundishapour University of Medical Sciences, Ahvaz, Iran
3 Faculty of Medicine, Jundishapour University of Medical Sciences, Ahvaz, Iran
4 Department of Chemistry, Behbahan Branch, Islamic Azad University, Behbahan, Iran

Click here for correspondence address and email

Date of Web Publication3-Mar-2015
 

   Abstract 

Although the life expectancy of patients with end-stage renal disease (ESRD) has improved in recent years, it is still far below that of the general population. In this retrospective study, we compared the survival of patients with ESRD receiving hemodialysis (HD) versus those on peritoneal dialysis (PD). The study was conducted on patients referred to the HD and PD centers of the Emam Khomini Hospital and the Aboozar Children's Hospital from January 2007 to May 2012 in Ahvaz, Iran. All ESRD patients on maintenance HD or PD for more than two months were included in the study. The survival was estimated by the Kaplan-Meier method and the differences between HD and PD patients were tested by the log-rank test. Overall, 239 patients, 148 patients on HD (61.92%) and 91 patients on continuous ambulatory PD (CAPD) (38.55%) with mean age of 54.1 ± 17 years were enrolled in the study. Regardless of the causes of ESRD and type of renal replacement therapy (RRT), one-, two- and three-year survival of patients was 65%, 51% and 35%, respectively. There was no significant difference between type of RRT in one- (P-value = 0.737), two- (P-value = 0.534) and three- (P-value = 0.867) year survival. There was also no significant difference between diabetic and non-diabetic patients under HD and CAPD in the one-, two- and three-year survival. Although the three-year survival of diabetic patients under CAPD was lower than that of non-diabetic patients (13% vs. 34%), it was not statistically significant (P-value = 0.50). According to the results of the current study, there is no survival advantage of PD during the first years of initiation of dialysis, and the one-, two- and three-year survival of HD and PD patients is also similar.

How to cite this article:
Beladi Mousavi SS, Hayati F, Valavi E, Rekabi F, Mousavi MB. Comparison of survival in patients with end-stage renal disease receiving hemodialysis versus peritoneal dialysis. Saudi J Kidney Dis Transpl 2015;26:392-7

How to cite this URL:
Beladi Mousavi SS, Hayati F, Valavi E, Rekabi F, Mousavi MB. Comparison of survival in patients with end-stage renal disease receiving hemodialysis versus peritoneal dialysis. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2019 Nov 14];26:392-7. Available from: http://www.sjkdt.org/text.asp?2015/26/2/392/152559

   Introduction Top


End-stage renal disease (ESRD) is one of the major life-threatening diseases. The rising incidence rate and the survival rate each year has increased the number of patients and imposes a major social and economic burden on most countries. [1],[2] There are three principal choices for renal replacement therapy (RRT), including hemodialysis (HD), peritoneal dialysis (PD) and kidney transplantation (KTP). Selecting one of these modalities is influenced by a number of considerations such as availability and convenience, comorbid conditions and socioeconomic factors. [3],[4] KTP is generally accepted as the optimal form of RRT for selected patients with ESRD, and it improves the quality of life and reduces the mortality risk for most patients when compared with maintenance dialysis. However, given the rapid rise in the incidence and prevalence of ESRD and the shortage of donor kidneys, most patients with ESRD will need some form of dialysis (PD or HD). [5],[6],[7],[8],[9] Although mortality rates among dialysis patients have decreased over the last few years, the survival of these patients is still much lower than that of the general population. Many studies have been performed around the effect of different factors on the survival of ESRD patients undergoing dialysis, including method of RRT, inadequate dialysis, etiology of renal failure and presence of comorbid disease in developed countries. [10],[11],[12],[13] However, only a few studies have been performed in developing countries like Iran. In the present study, we compared the survival of patients with ESRD according to the type of dialysis (HD versus PD) in Ahvaz city, Iran.


   Materials and Methods Top


This retrospective study was conducted on ESRD patients referred to the HD and PD centers of the Emam Khomini Hospital and the Aboozar Children's Hospital in Ahvaz city, Iran, from January 2007 to May 2012. The study have approved by the Research Center of the Ahvaz Jundishapur University of Medical Sciences. The ESRD was defined as permanent and irreversible loss of renal function requiring RRT. HD was performed for 3-4 h, three times a week, using semi-synthetic (cellulose diacetate) or synthetic (polysulfone) dialyzer membranes and the bicarbonate-based dialysate at a delivered bicarbonate concentration of 35 mEq/L. Blood flow rate was maintained at 200-400 mL/min and the dialysate flow rate was maintained at 500 mL/min.

PD was performed as continuous ambulatory peritoneal dialysis (CAPD) with 2000 mL bag exchanges (900-1100 mL/m 2 in children) four to six times per day. The type of PD dialysate was selected by a nephrologist according to the clinical condition of the patients.

The ESRD patients on maintenance HD and CAPD, who were dialyzed for more than 60 days, were included. Patients who were dialyzed because of acute renal failure were excluded. Other exclusion criteria were incomplete data of the patients, patients who had kidney transplantation as a RRT at any time before and during the study and patients who died within two months after initiation of dialysis.

The Statistical Package for Social Sciences (SPSS) version 15 software was used for data analysis. The one-, two- and three-year survival of the HD and PD groups were estimated by the Kaplan-Meier method. If the follow-up of each patient in both groups was lower than two or three years, he or she was excluded from the analysis of that survival. The differences between survivals of both groups were tested by use of the log-rank test. Significant differences between both groups were determined at the <0.05 level.


   Results Top


Overall, 239 patients - 135 males (56.48%) with ESRD, 148 patients on HD (61.92%) and 91 patients on CAPD (38.55%) - were enrolled in the study. At the beginning of the study, the mean age of all patients was 54.1 ± 17 years, without any significant difference between males and females (P = 0.98). Six patients were younger than 15 years, with a mean age of 11.2 years (two patients on HD and patients on CAPD).

Regardless of the cause of ESRD and type of RRT, the one-, two- and three-year survival of patients were 65%, 51% and 35%, respectively. It was 63%, 53% and 38% in patients receiving HD and 67%, 46% and 29% in patients receiving CAPD. There was no significant difference between type of RRT in the one-(P-value = 0.737), two- (P-value = 0.534) and three- (P-value = 0.867) year survival [Figure 1]. There was also no significant difference between males and females in the one- (P-value = 0.80), two- (P-value = 0.75) and three- (P-value = 0.92) year survivals in HD and CAPD patients. All patients younger than 15 years old survived during this period. We evaluated the effect of various blood groups on the one-, two- and three-year survival of our patients, and we did not find any association (P >0.05).
Figure 1: Survival of patients according to type of renal replacement therapy.

Click here to view


ESRD patients were divided in two groups: Diabetic (88 patients: 36.8%) and and non-diabetic patients. There was no significant difference between diabetic (60 patients: 40.5%) and non-diabetic patients receiving HD in 1-year survival (67% vs. 59%, P-value = 0.33), 2-year survival (59% vs. 49%, P-value = 0.93) and 3-year survival (35% vs. 42%, P-value = 0.73) [Figure 2].
Figure 2: Survival of patients according to diabetic status in hemodialysis patients.

Click here to view


There was also no significant difference between diabetic (28 patients: 28.5%) and non-diabetic patients receiving CAPD in the one-(65% vs. 68%, P-value = 0.25) and two-year survivals (52% vs. 44%, P-value = 0.26). Although the three-year survival of diabetic patients receiving CAPD was lower than non-diabetic patients (13% vs. 34%), it was not statistically significant (P-value = 0.50) [Figure 3].
Figure 3: Survival of patients according to diabetic status in CAPD patients

Click here to view



   Discussion Top


Our study is the first study in Khuzestan province, Iran that compared the survival results of HD and PD patients. According to the results of the current study, regardless of the causes of ESRD, there are no significant differences between HD and PD patients in one-, two- and three-year survival.

There are some epidemiological studies and practically all retrospective and observational studies among patients with ESRD concerning the relative effect upon mortality of PD versus HD. The results of these investigations have been conflicting and, in most of them, the mortality in HD was not different from the result of our study, but there was a relative advantage or a relative disadvantage upon survival in PD in other studies. [14],[15],[16],[17],[18] It appears likely that the variable results are due to differences in the age, race, causes of ESRD, comorbid diseases, lack of extended follow-up, the time of initiation of dialysis, the type of analytical method utilized, selection bias and other factors. [19],[20],[21] For example, regardless of the type of dialysis, the risk of death varies with age, and older patients on PD as well as HD have a relatively increased mortality. [21] The risk of death also varies with the presence or absence of diabetes mellitus as the cause of ESRD, regardless of the dialysis modalities. Several studies demonstrated that the survival among dialysis patients is worst in patients with diabetic nephropathy compared with all other cause of ESRD, likely due to the high prevalence and severity of cardiovascular disease and higher susceptibility to infectious complications and foot ulcers among these patients. [22],[23] However, in our study, we did not find a significant difference between diabetic and non-diabetic patients receiving HD and/or CAPD in one-, two- and three-year survival probably due to the short follow-up of our study and/or the recent advances in the management of diabetic patients.

Some evidences are suggested for the survival advantage of PD during the first years of initiation of dialysis. For example, Fenton et al concluded that the survival of Canadian ESRD patients receiving PD is significantly higher than HD patients in the first two years after initiation of dialysis. [18] The results of the Heaf et al study also showed a survival advantage for Danish PD patients for the first years of dialysis. [24] In contrast to these studies, we did not find a survival advantage of PD in the first years after initiation of dialysis. Similar to the results of our study, Termorshuizen et al reported that mortality of patients with ESRD was not different between types of RRT (HD versus PD) during the first two years after initiation of dialysis. However; in the Termorshuizen study, PD patients had a higher relative mortality compared with HD patients after two years of treatment. [25]

Our study is limited by short duration and lack of information regarding various comorbid conditions in both PD and HD patients. In addition, other factors that have been reported to affect dialysis mortality, including adequacy of dialysis, nutritional markers and the causes of mortality, were also not evaluated in our study. Therefore, additional studies are required to definitely determine whether HD or PD has any survival advantage or disadvantage as a RRT in the management of ESRD, particularly with respect to age, the presence or absence of diabetes mellitus as a cause of ESRD, time of initiation of dialysis and various comorbid conditions at the start of dialysis.


   Conclusion Top


Although RRT with dialysis decreases the complications of uremia, the long-term patient survival remains an important issue in these patients. Although some evidences have suggested a survival advantage of PD during the first years of initiation of dialysis, the results of the current study show that there was no significant advantage of PD compared with HD in one-, two- and three-year survival. In addition, we did not find a significant difference in the survival of diabetic and non-diabetic patients.


   Acknowledgment Top


This study was supported by the Vice Chancellor of the research center in the Jundishapur University of Medical Sciences (No: U-90235).

Funding/Support: Ahvaz Jundishapur University of Medical Sciences.

Conflict of Interest: None declared.

 
   References Top

1.
Zelmer JL. The economic burden of end-stage renal disease in Canada. Kidney Int 2007; 72:1122-9.  Back to cited text no. 1
    
2.
Prodjosudjadi W. Incidence, prevalence, treatment and cost of end-stage renal disease in Indonesia. Ethn Dis 2006;16(2 Suppl 2):S2-14-6.  Back to cited text no. 2
    
3.
Tonelli M, Hemmelgarn B, Culleton B, et al. Mortality of Canadians treated by peritoneal dialysis in remote locations. Kidney Int 2007; 72:1023-8.  Back to cited text no. 3
    
4.
Mehrotra R, Khawar O, Duong U, et al. Ownership patterns of dialysis units and peritoneal dialysis in the United States: Utilization and outcomes. Am J Kidney Dis 2009;54:289-98.  Back to cited text no. 4
    
5.
Schnuelle P, Lorenz D, Trede M, Van Der Woude FJ. Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol 1998;9:2135-41.  Back to cited text no. 5
    
6.
Snyder JJ, Kasiske BL, Gilbertson DT, Collins AJ. A comparison of transplant outcomes in peritoneal and hemodialysis patients. Kidney Int 2002;62:1423-30.  Back to cited text no. 6
    
7.
Arend SM, Mallat MJ, Westendorp RJ, van der Woude FJ, van Es LA. Patient survival after renal transplantation; more than 25 years follow-up. Nephrol Dial Transplant 1997;12: 1672-9.  Back to cited text no. 7
    
8.
Nogueira JM, Haririan A, Jacobs SC, Cooper M, Weir MR. Cigarette smoking, kidney function, and mortality after live donor kidney transplant. Am J Kidney Dis 2010;55:907-15.  Back to cited text no. 8
    
9.
Port FK, Dykstra DM, Merion RM, Wolfe RA. Trends and results for organ donation and transplantation in the United States, 2004. Am J Transplant 2005;5:843-9.  Back to cited text no. 9
    
10.
Wallen MD, Radhakrishnan J, Appel G, Hodgson ME, Pablos-Mendez A. An analysis of cardiac mortality in patients with new-onset end-stage renal disease in New York State. Clin Nephrol 2001;55:101-8.  Back to cited text no. 10
    
11.
O'Seaghdha CM, Foley RN. Septicemia, access, cardiovascular disease, and death in dialysis patients. Perit Dial Int 2005;25:534-40.  Back to cited text no. 11
    
12.
Goodkin DA, Bragg-Gresham JL, Koenig KG, et al. Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS). J Am Soc Nephrol 2003;14:3270-7.  Back to cited text no. 12
    
13.
Miskulin D, Bragg-Gresham J, Gillespie BW, et al. Key comorbid conditions that are predictive of survival among hemodialysis patients. Clin J Am Soc Nephrol 2009;4:1818-26.  Back to cited text no. 13
    
14.
Panagoutsos S, Kantartzi K, Passadakis P, et al. Timely transfer of peritoneal dialysis patients to hemodialysis improves survival rates. Clin Nephrol 2006;65:43-7.  Back to cited text no. 14
    
15.
Vonesh EF, Moran J. Mortality in end-stage renal disease: A reassessment of differences between patients treated with hemodialysis and peritoneal dialysis. J Am Soc Nephrol 1999; 10:354-65.  Back to cited text no. 15
    
16.
Murphy SW, Foley RN, Barrett BJ, et al. Comparative mortality of hemodialysis and peritoneal dialysis in Canada. Kidney Int 2000; 57:1720-6.  Back to cited text no. 16
    
17.
Locatelli F, Marcelli D, Conte F, et al. Survival and development of cardiovascular disease by modality of treatment in patients with end-stage renal disease. J Am Soc Nephrol 2001; 12:2411-7.  Back to cited text no. 17
    
18.
Fenton SS, Schaubel DE, Desmeules M, et al. Hemodialysis versus peritoneal dialysis: A comparison of adjusted mortality rates. Am J Kidney Dis 1997;30:334-42.  Back to cited text no. 18
    
19.
Johansen KL, Zhang R, Huang Y, et al. Survival and hospitalization among patients using nocturnal and short daily compared to conventional hemodialysis: A USRDS study. Kidney Int 2009;76:984-90.  Back to cited text no. 19
    
20.
Ganesh SK, Hulbert-Shearon T, Port FK, Eagle K, Stack AG. Mortality differences by dialysis modality among incident ESRD patients with and without coronary artery disease. J Am Soc Nephrol 2003;14:415-24.  Back to cited text no. 20
    
21.
Xue JL, Everson SE, Constantini EG, et al. Peritoneal and hemodialysis: II. Mortality risk associated with initial patient characteristics. Kidney Int 2002;61:741-6.  Back to cited text no. 21
    
22.
Beladi Mousavi SS, Hayati F, Alemzadeh Ansari MJ, et al. Survival at 1, 3, and 5 years in diabetic and nondiabetic patients on hemodialysis. Iran J Kidney Dis 2010;4:74-7.  Back to cited text no. 22
    
23.
Nishimura R, Dorman JS, Bosnyak Z, et al. Incidence of ESRD and survival after renal replacement therapy in patients with type 1 diabetes: a report from the Allegheny County Registry. Am J Kidney Dis 2003;42:117-24.  Back to cited text no. 23
    
24.
Heaf JG, Lokkegaard H, Madsen M. Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant 2002;17:112-7.  Back to cited text no. 24
    
25.
Termorshuizen F, Korevaar JC, Dekker FW, et al. Hemodialysis and peritoneal dialysis: comparison of adjusted mortality rates according to the duration of dialysis: Analysis of The Netherlands Cooperative Study on the Adequacy of Dialysis 2. J Am Soc Nephrol 2003; 14:2851-60.  Back to cited text no. 25
    

Top
Correspondence Address:
Dr. Ehsan Valavi
Division of Pediatric Nephrology, Chronic Renal Failure Research Center Abuzar Children's Hospital, Ahvaz
Iran
Login to access the Email id


DOI: 10.4103/1319-2442.152559

PMID: 25758900

Rights and Permissions


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

Top
   
 
 
    Similar in PUBMED
    Search Pubmed for
    Search in Google Scholar for
    Email Alert *
    Add to My List *
* Registration required (free)  
 


 
    Abstract
   Introduction
    Materials and Me...
   Results
   Discussion
   Conclusion
   Acknowledgment
    References
    Article Figures
 

 Article Access Statistics
    Viewed3863    
    Printed34    
    Emailed0    
    PDF Downloaded796    
    Comments [Add]    

Recommend this journal