Mortality Risk in Elderly Patients Varies with Dialysis Modality

Clinical Journal of the American Society of Nephrology. 2015.10(6):983-993.

Elderly patients with end-stage renal disease may he at high risk for death, but have a low chance of receiving kidney transplantation. The optimal choice between hemodialysis and peritoneal dialysis in this population has not been resolved.

Seung Seok Han, MD, and colleagues at the Seoul National University College of Medicine, Seoul, Korea, conducted a meta-analysis of data on 13,065 incident dialysis patients ≥65 years of age in Korea; of those, 10,657 received hemodialysis and 2390 received peritoneal dialysis. The data were obtained from the Korean Health Insurance dataset.

The researchers utilized several statistical approaches, including the multivariate Cox model, to compare mortality between the two groups (hemodialysis patients and peritoneal dialysis patients). Subsequently, a meta-analysis of previous population-based comparison studies published since 2000 and the Korean dataset was performed.

During a mean duration of 1.8 years (maximum, 5 years), the Korean peritoneal dialysis group had a higher mortality rate than the Korean hemodialysis group (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.13-1.28; P<.001 by multivariate Cox model). In the presence of certain conditions, including diabetes mellitus or longer duration of dialysis, the discrepancy between the two modalities was greater.

The researchers reviewed 15 articles involving >631,421 elderly patients for the meta-analysis. Compared with hemodialysis, the pooled HR with peritoneal dialysis was 1.10 (95% CI, 1.01-1.20). When stratified by confounding factors, the meta-analysis resulted in a particularly strong survival benefit in subgroups of hemodialysis patients with diabetes mellitus, those with dialysis duration of more than 1 year, or in subgroups that contained cohorts starting dialysis in the 1990s.

“A meta-analysis that included results in Korean patients suggests a higher risk for death in elderly patients receiving [peritoneal dialysis] than in those receiving [hemodialysis],” the researchers said.