Trends in Comorbidities with Hemodialysis and Peritoneal Dialysis

New Orleans—Beginning in 1995, the US Renal Data System has collected data on comorbid conditions in patients receiving hemodialysis or peritoneal dialysis. Rita L. McGill, MD, and colleagues utilized the data to assess the prevalence of various comorbidities in those patient populations over 20 years; trends in both groups were compared. The researchers reported results during a poster session at Kidney Week 2017 in a poster titled Comorbid Disease Trends in Hemodialysis and Peritoneal Dialysis Patients.

The analysis included all first-time hemodialysis and peritoneal dialysis from 1996 to 2015; analyses were conducted by year of initiation. To align data obtained from the 1995 and 2005 Medical Evidence forms, diabetes and cardiovascular disease were condensed into single variables. Logistic regression was used to evaluate the proportions of comorbid conditions, treating year of initiation as a continuous variable, stratifying by dialysis type and adjustment for age, sex, and race. Five-year prevalence trends were expressed as odds ratios (ORs) and 95% confidence intervals; OR >1 represented increasing prevalence.

The analyses included data on 1,864,386 patients receiving hemodialysis and 157,395 patients receiving peritoneal dialysis. Peritoneal dialysis patients were consistently 5 to 6 years younger than hemodialysis patients.

There was a decrease in cardiovascular disease in patients on peritoneal dialysis; prevalence of cardiovascular disease stayed flat among hemodialysis patients. Hypertension, diabetes mellitus, and lung disease (chronic obstructive pulmonary disease [COPD]) increased in patients on hemodialysis, while peripheral vascular disease decreased. In patients on peritoneal disease, the increase in diabetes mellitus was smaller compared with hemodialysis patients; COPD and peripheral vascular disease decreased in peritoneal dialysis patients. Hypertension increased in the peritoneal dialysis group. There were no significant changes in stroke or cancer over time.

In conclusion, the researchers said, “While hemodialysis and peritoneal dialysis patients in the United States are both becoming older, and increasingly hypertensive and diabetic, the comorbid disease burdens have been diverging over the past 20 years, resulting in peritoneal patients having less diabetes mellitus, cardiovascular disease, and COPD than their counterparts receiving hemodialysis.”

Source: McGill RL, Bragg-Gresham JL, He K, Lacson EK, Miskulin D, Saran R. Comorbid disease trends in hemodialysis and peritoneal dialysis patients. Abstract of a poster presented at the American Society of Nephrology 2017 Kidney Week, November 2, 2107, New Orleans, Louisiana.