Hemodialysis versus Peritoneal Dialysis: A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease.
Hemodialysis versus Peritoneal Dialysis: A Comparison of Survival Outcomes in South-East Asian Patients with End-Stage Renal Disease.
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DOI：
10.1371/journal.pone.0140195
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Luo N
中科院分区：
文献类型：
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作者：
Yang F;Khin LW;Lau T;Chua HR;Vathsala A;Lee E;Luo N
比较血液透析（HD）和腹膜透析（PD）患者生存的研究得出了相互矛盾的结果，而且东南亚没有这样的研究。本研究旨在比较新加坡患有HD和PD的终末期肾病（ESRD）患者开始透析的生存结果。使用灵活的Royston-Parmar （RP）模型分析了2005-2010年871例开始透析并伴有HD （n = 641）或PD （n = 230）的ESRD患者最长5年的生存数据。该模型还应用于225对倾向评分匹配的患者对和按年龄、糖尿病和心血管疾病定义的亚组的子样本。在调整了社会人口统计学和临床特征的影响后，PD患者的死亡风险高于HD患者（风险比[HR]: 2.08； 95%可信区间[CI]: 1.67-2.59; p<0.001），尽管在治疗的前12个月，两种方式的死亡率没有显著差异。一致地，在匹配的亚样本中，开始PD的患者比开始HD的患者死亡风险更高（HR: 1.73, 95% CI: 1.30-2.28, p<0.001）。亚组分析显示，在没有糖尿病或心血管疾病的年轻患者（≤65岁）中，PD的生存结局可能与HD相似或更好。在新加坡，ESRD患者开始透析时伴有HD的患者比开始透析时伴有PD的患者有更好的生存结果，尽管在年轻和健康的患者中两种透析方式的生存结果可能没有差异。这些发现可能会因选择偏倚而混淆，因为在该队列研究中，患者没有随机分配到两种透析方式。
Studies comparing patient survival of hemodialysis (HD) and peritoneal dialysis (PD) have yielded conflicting results and no such study was from South-East Asia. This study aimed to compare the survival outcomes of patients with end-stage renal disease (ESRD) who started dialysis with HD and PD in Singapore. Survival data for a maximum of 5 years from a single-center cohort of 871 ESRD patients starting dialysis with HD (n = 641) or PD (n = 230) from 2005–2010 was analyzed using the flexible Royston-Parmar (RP) model. The model was also applied to a subsample of 225 propensity-score-matched patient pairs and subgroups defined by age, diabetes mellitus, and cardiovascular disease. After adjusting for the effect of socio-demographic and clinical characteristics, the risk of death was higher in patients initiating dialysis with PD than those initiating dialysis with HD (hazard ratio [HR]: 2.08; 95% confidence interval [CI]: 1.67–2.59; p<0.001), although there was no significant difference in mortality between the two modalities in the first 12 months of treatment. Consistently, in the matched subsample, patients starting PD had a higher risk of death than those starting HD (HR: 1.73, 95% CI: 1.30–2.28, p<0.001). Subgroup analysis showed that PD may be similar to or better than HD in survival outcomes among young patients (≤65 years old) without diabetes or cardiovascular disease. ESRD patients who initiated dialysis with HD experienced better survival outcomes than those who initiated dialysis with PD in Singapore, although survival outcomes may not differ between the two dialysis modalities in young and healthier patients. These findings are potentially confounded by selection bias, as patients were not randomized to the two dialysis modalities in this cohort study.