Survival advantage of planned haemodialysis over peritoneal dialysis: a cohort study
Survival advantage of planned haemodialysis over peritoneal dialysis: a cohort study
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DOI：
10.1093/ndt/gfy007
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发表时间：
2018-08-01
影响因子：
6.1
通讯作者：
Krummel, Thierry
中科院分区：
文献类型：
--
作者：
Thiery, Alicia;Severac, Francois;Krummel, Thierry
背景资料。以往比较血液透析(HD)和腹膜透析(PD)的结果的研究得出了相互矛盾的结果。这项研究的目的是比较2006年至2008年在全国肾脏病登记(Reseau Epidformologie Et Information En Nephrologie)中开始肾脏替代治疗(RRT)的成人事件患者队列中计划中的HD患者和PD患者的存活率。排除急诊开始RRT或2个月内停止RRT的患者。调整的COX模型、倾向分数匹配和边际结构模型(MSM)被用来弥补随机化的不足，并通过时间依赖的处理和混杂因素(包括移植审查、随时间的形态变化和时变的协变量)从纵向数据中提供因果推断。在13767名透析患者中，13%的患者在开始RRT时服用PD，87%的患者服用HD。HD组和PD组的中位生存期分别为53.5个月和38.6个月，中位生存期分别为4.45年和3.21年。无论使用哪种模型，HD患者的生存率都有一致的优势：使用倾向评分的COX模型的风险比(HR)为0.76[95%可信区间(95%CI)0.69-0.84]；在每次治疗变化进行审查的COX模型中，HR为0.67(95%CI 0.62-0.73)；MSMS为0.82(95%CI 0.69-0.97)。然而，MSM倾向于缩小PD和HD患者之间的生存差距。这项大型队列研究使用了各种统计方法来最小化偏差，似乎表明计划性HD比PD有更好的存活率。
Background. Previous studies comparing the outcomes in haemodialysis (HD) with those in peritoneal dialysis (PD) have yielded conflicting results.Methods. The aim of the study was to compare the survival of planned HD versus PD patients in a cohort of adult incident patients who started renal replacement therapy (RRT) between 2006 and 2008 in the nationwide REIN registry (Reseau Epidemiologie et Information en Nephrologie). Patients who started RRT in emergency or stopped RRT within 2 months were excluded. Adjusted Cox models, propensity score matching and marginal structural models (MSMs) were used to compensate for the lack of randomization and provide causal inference from longitudinal data with time-dependent treatments and confounders including transplant censorship, modality change over time and time-varying covariates.Results. Among a total of 13 767 dialysis patients, 13% were on PD at initiation of RRT and 87% were on HD. The median survival times were 53.5 months or 4.45 years and 38.6 months or 3.21 years for patients starting on HD and PD, respectively. Regardless of the model used, there was a consistent advantage in terms of survival for HD patients: hazard ratio (HR) 0.76 [95% confidence interval (95% CI) 0.69-0.84] with the Cox model using propensity score; HR 0.67 (95% CI 0.62-0.73) in the Cox model with censorship for each treatment change; and HR 0.82 (95% CI 0.69-0.97) with MSMs. However, MSMs tended to reduce the survival gap between PD and HD patients.Conclusion. This large cohort study using various statistical methods to minimize the bias appears to demonstrate a better survival in planned HD than in PD.