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Perit Dial Int 27(Supplement_3): 16- 2007
© 2007 International Society for Peritoneal Dialysis
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Clinical Experience

Improving Chronic Peritoneal Dialysis (CPD) Outcomes but Unchanged Maintenance Hemodialysis (MHD) Outcomes in the United States

O. Khawar1, D. Kermah2, L. Fried3, K. Kalantar-Zadeh1, K. Norris2, A. Nissenson4 and R. Mehrotra1

LA Biomed at Harbor-UCLA Med Cntr,1 Torrance; Charles Drew Univ,2 Los Angeles, California; VA Pittsburgh Health Care Sys,3 Pittsburgh, Pennsylvania; UCLA Med Cntr,4 Los Angeles, California, USA.

Objective: Published registry studies used incident patients (pts) from the early 1990s to compare CPD and MHD outcomes. We hypothesized that there may have been differential changes in outcomes of CPD and MHD pts over the past decade. Methods: In this study, the 12-month outcomes [starting from day 90 of end-stage renal disease (ESRD)] of incident CPD and HD pts in the USA were ascertained using data from the United States Renal Data System. Technique failure (death or transfer to alternate dialysis modality, censored from transplantation) was compared over four 2-year periods (P1, 1996–'97; P2, 1998–'99; P3, 2000–'01; P4, 2002–'03). Multivariate Cox proportional hazards regression analyses were carried out to assess the effect of cohort period on technique survival. Results: During the 8-year period, a total of 606777 adult pts started maintenance dialysis therapy and survived 90 days: MHD, 550435 and CPD, 56242. Data on technique survival were available in 98.6% of MHD and 98.8% of CPD pts. While the 12-month unadjusted technique survival of the incident CPD pts improved over the 4 cohort periods (P1, 62.8%; P2, 63.5%; P3, 64.7%; and, P4 67.2%), largely as a result of reduction in mortality, that of MHD pts remained unchanged (P1, 73.1%; P2, 72.7%; P3, 72.3%; P4, 73.4%). In a Cox model of CPD, after adjusting for case-mix, demographics, and laboratory data, the hazard ratio for technique failure progressively decreased: P2, 0.92 (0.87, 0.97); P3, 0.89 (0.84, 0.94); P4, 0.82 (0.77, 0.87) compared to P1. There was no significant change in the adjusted hazards for technique survival among pts undergoing MHD: P2, 0.90 (0.77, 1.05); P3, 0.97 (0.84, 1.12); P4, 0.99 (0.85, 1.14) compared to P1. Conclusions: Thus, in the USA, between 1996 and 2003, the 12-month outcomes for incident CPD pts appear to have improved while that of MHD pts has remained unchanged. It may be important to reexamine the comparative outcomes of CPD and MHD pts using a contemporary cohort.






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