Comparative analysis of patients’ survival on hemodialysis vs. peritoneal dialysis and identification of factors associated with death

Vicentini, Carolina Aparecida de Almeida; Ponce, Daniela

doi:10.1590/2175-8239-JBN-2021-0242en

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Brazilian Journal of Nephrology

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Original Article • Braz. J. Nephrol. 45 (1) • Jan-Mar 2023 • https://doi.org/10.1590/2175-8239-JBN-2021-0242en copy

Comparative analysis of patients’ survival on hemodialysis vs. peritoneal dialysis and identification of factors associated with death

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction:

There are several studies comparing the outcomes of patients treated with peritoneal dialysis (PD) and hemodialysis (HD), and most are divergent.

Methods:

This is a cohort study that followed patients with incident PD and HD in a planned and unplanned way, in a dialysis unit of the HCFMB from 01/2014 to 01/2019, until the outcome. We collected clinical and laboratory data. The PD and HD groups, death and non-death outcomes, were compared using the chi-square test for categorical variables and t-test, or Mann-Whitney test for continuous variables. Kaplan Meier curve and log-rank test were used for survival. Multivariate analysis was performed using the Cox regression. The significant difference was p < 0.05.

Results:

We had 592 patients, 290 treated by HD and 302 by PD. The mean age was 59.9 ± 16.8, with a predominance of males (56.3%), the main underlying disease was diabetes (45%); 29% of the patients died. There was no difference in the survival of patients treated by HD and PD. The oldest age (1.018 (95% CI 1.000-1.037; p=0.046)) was identified as a risk factor for death, while the highest number of infection-free days (0.999 (95% CI 0.999-1.000; p=0.003 )) as a protective factor.

Conclusion:

The analysis reinforced that the survival of patients on HD and PD was similar. Higher age and shorter infection-free time were associated with death.

Keywords:
Survival; Death; Renal Dialysis; Peritoneal Dialysis

Variables	Hemodialysis (n = 290)	Peritoneal dialysis GT (n = 302)	P
Age (years)^* * Mean ± standard deviation,	60.7 ± 16.4	59.0 ± 17.1	0.1
Creatinine^ Median (quartiles)	6.5(4.9-8.5)	6.8(5.0-8.3)	0.3
Creatinine 6m^ Median (quartiles)	8.1(6.2-10.3)	7.3(5.9-9.6)	0.01
Albumin^ Median (quartiles)	3.5 (3.0-3.9)	3.4(2.8-3.8)	0.01
Albumin 6m^ Median (quartiles)	3.8(3.5-4.1)	3.3(2.5-3.8)	<0.0001
PTH^ Median (quartiles)	167.0 (79.3-307.8)	181.0(98.0-328.5)	0.1
PTH 6m^ Median (quartiles)	206.0(112.0-351.3)	142.5(43.8-269.0)	<0.0001
Hemoglobin^ Median (quartiles)	9.5(8.4-10.7)	10(8.9-11.4)	0.001
Hemoglobin 6m^ Median (quartiles)	11.3(10.0-12.4)	10.9(9.3-12.1)	0.03
P^ Median (quartiles)	5.7(4.6-7.1)	5.8 (4.7-7.4)	<0.0001
P 6m^ Median (quartiles)	5.3(4.5-6.4)	4.8(3.8-5.7)	<0.0001
Kt/v 6 m^ Median (quartiles)	0.0(0.0-1.3)	2.1(1.8-1.5)	< 0.0001
No of comorbidities^ Median (quartiles)	3.0(2.0-4.0)	2.0(1.0-3.0)	0.0001
Infection-free days ^ Median (quartiles)	348.0 (61.0-752.0)	140(32.0-309.5)	<0.0001
No of hospital admissions^ Median (quartiles)	1.0(1.0-3.0)	0.0(0.0-1.0)	<0.0001
Survival days^ Median (quartiles)	483.0(148.0-1139.0)	367(111.8-677.8)	<0.0001
Males	153(52.8)	172(57.0)	0.3
Diabetic	138(47.6)	138(45.7)	0.6
2 or more comorbidities	238(82.1)	63(20.9)	<0.0001
Infection	66(22.8)	93(30.8)	0.03
Second episode of infection	26(9.0)	26(8.6)	0.9
Hospital admission	230(79.3)	88(29.1)	<0.0001
Death	108(37.2)	63(20.9)	<0.0001
Function recovery	6(2.1)	31(10.6)	<0.0001
Transplant	26(9.0)	34(11.3)	0.4

Variables	HD + PD Death (n = 171)	HD + PD No death (n = 421)	P
Age (years)^* * Mean ± standard deviation,	67.1 ± 13.2	56.9 ± 17.2	< 0.0001
Creatinine^ Median (quartiles)	5.9(4.5-7.5)	7.1(5.3-8.7)	< 0.0001
Creatinine 6m^* * Mean ± standard deviation,	7.5 ± 2.6	8.2 ± 2.9	0.03
Albumin^ Median (quartiles)	3.4(2.8-3.7)	3.5(3.0-3.9)	0.1
Albumin 6m^ Median (quartiles)	3.6(3.2-4.0)	3.6(3.0-4.0)	0.5
PTH^ Median (quartiles)	155(71.5-244.0)	189(101.0-338.0)	0.0022
PTH 6m^ Median (quartiles)	190.0(92.8-298.5)	175.0(83.7-320.0)	0.4
Hemoglobin^ Median (quartiles)	9.5(8.4-11.0)	9.9(8.7-11.1)	0.10
Hemoglobin 6m^ Median (quartiles)	11.0(9.8-12.4)	11.1(9.9-12.3)	0.4
P^ Median (quartiles)	5.2(4.1-6.6)	5.4(4.5-7.0)	0.02
P 6 months^ Median (quartiles)	4.8(3.8-6.2)	4.8(4.0-6.0)	0.5
Kt/v 6m^ Median (quartiles)	1.1(0.0-1.8)	1.4(0.0-2.0)	0.01
No of comorbidities^* * Mean ± standard deviation,	2.9 ± 1.7	2.3 ± 1.7	0.0001
No of hospital admissions^ Median (quartiles)	1.0 (1.0-2.0)	0.0 (0.0-1.0)	< 0.0001
Infection-free days^ Median (quartiles)	165(35.3-350.3)	223(54.0-536.0)	0.0015
Survival days^ Median (quartiles)	304.5(77.8-624.3)	466(148.0-909.0)	0.0001
Males	96(56.1)	229(46.6)	0.7
2 or more comorbidities	150(87.7)	318(75.5)	0.001
Infection	46(26.9)	113(26.8)	1.0
Second infection episode	15(8.8)	37(8.8)	1.0
Diabetic	95(55.6)	181(43.0)	0.01
Hospital admissions	127(74.3)	191(45.4)	< 0.0001

Variables	HD death (n = 108)	HD No death (n = 182)	P	PD Death (n = 63)	PD No death (n = 236)	p
Age (years)^* * Mean ± standard deviation,	66.6 ± 13.6	57.3 ± 17.0	< 0.001	68.0(61.0-76.0)	59.0(45.0-70.0)	<0.0001
Creatinine^ Median (quartiles)	6.1(4.6-7.6)	7.0(5.2-8.8)	0.002	5.9(4.1-7.1)	7.1(5.3-8.5)	0.0004
Creatinine 6m^* * Mean ± standard deviation,	7.6 ± 2.6	8.8 ± 3.0	0.003	7.4(6.5-8.8)	7.3(5.7-9.8)	0.4
Albumin^ Median (quartiles)	3.4(2.8-3.7)	3.6(3.1-3.9)	0.003	3.4 ± 0.7	3.3 ± 0.6	0.2
Albumin 6m^ Median (quartiles)	3.7(3.4-4.1)	3.8(3.6-4.2)	0.005	3.2(2.5-3.7)	3.3(2.7-3.8)	0.2
PTH ^ Median (quartiles)	154(68.0-254.0)	182(85.6-323.0)	0.1	155.5(80.4-236.0)	189.0(111.0-365.8)	0.01
PTH 6m^ Median (quartiles)	206(107.3-316.0)	211(121.8-365.3)	0.3	134.0(50.3-267.0)	145.0(43.0-269.5)	0.4
Hemoglobin^ Median (quartiles)	9.3(8.4-10.9)	9.7(8.4-10.7)	0.2	10.1(8.7-11.4)	10.0(8.9-11.4)	0.5
Hemoglobin 6m^* * Mean ± standard deviation,	11.1 ± 1.8	11.2 ± 2.0	0.4	10.9(9.3-12.1)	11.0(9.3-12.1)	0.4
P^ Median (quartiles)	5.0(3.8-6.4)	5.0(4.2-6.4)	0.2	5.5(4.7-7.0)	5.9(4.7-7.5)	0.2
P 6m^ Median (quartiles)	5.3(4.6-6.6)	5.3(4.6-6.1)	0.3	4.8(3.9-6.0)	4.8(3.7-5.7)	0.4
Kt/V 6m^ Median (quartiles)	1.1(0.9-1.4)	1.2(0.9-1.3)	0.5	2.2(1.9-2.5)	2.1(1.7-2.5)	0.3
No of comorbidities ^* * Mean ± standard deviation,	3.4 ± 1.7	2.8 ± 1.9	0.01	2.1 ± 1.5	1.9 ± 1.4	0.2
No of hospital stays^ Median (quartiles)	1.0(1.0-3.0)	1.0(0.8-2.0)	0.02	1.0(0.0-1.0)	0.0(0.0-0.0)	0.0002
BSI-free days^ Median (quartiles)	235.0(52.5-482.0)	434.0(97.0-882.0)	0.0002	-	-	-
Peritonitis-free days	-	-	-	95.0(29.0-250.0)	150.0(37.0-340.0)	0.046
ESI-free days^ Median (quartiles)	166(49.5-334.5)	320.5(72.3-666.3)	0.001	-	-	-
Survival days^ Median (quartiles)	326(90.5-745.0)	664.5(260.5-1331.0)	< 0.001	261.0(73.0-548.0)	390.0(125.0-706.0)	0.03
Diabetic	60(55.6)	78(42.9)	0.04	35(55.6)	103(43.1)	0.1
Males	55(50.9)	98(53.9)	0.6	41(65.1)	131(54.8)	0.1
2 or more comorbidities	96(88.9)	141(77.5)	0.02	53(84.1)	177(74.1)	0.1
BSI	23(21.3)	43(23.6)	0.7	-	-	-
ESI	36(33.3)	64(35.2)	0.8	13(20.6)	56(23.4)	0.6
Peritonitis	-	-	-	23(36.5)	70(29.9)	0.3
Hospital admissions	96(88.9)	134(73.6)	0.002	31(49.2)	57(23.9)	< 0.0001

	p	HR (Hazard ratio)	95.0% CI for HR
	p	HR (Hazard ratio)	Lower	Upper
Creatinine 6m	0.7	1.0	0.9	1.1
No of Hospital admissions	0.8	1.0	0.9	1.2
Hospital admissions	0.1	1.9	0.9	3.8
Diabetic	0.7	0.9	0.5	1.5
Comorbidities	0.1	1.1	1.0	1.3
Infection-free days	0.003	0.999	0.999	1.0
Kt/V 6m	0.8	1.0	0.8	1.2
Age	0.046	1.02	1.00	1.04
Creatinine	0.7	1.0	0.9	1.1
Phosphorus	1.0	1.0	0.9	1.0
Initial PTH	0.6	1.0	1.0	1.0

	p	HR (Hazard ratio)	95.0% CI for HR
	p	HR (Hazard ratio)	Lower	Upper
Albumin 6m	0.3	1.0	1.0	1.04
No of hospital admissions	0.6	1.0	0.9	1.2
Hospital admissions	0.6	1.3	0.5	3.3
Age	0.3	1.010	0.991	1.030
Creatinine	0.8	0.999	0.989	1.009
Creatinine 6m	0.4	0.996	0.988	1.005
Albumin	0.3	0.986	0.961	1.012
ESI-free days	0.2	1.000	0.999	1.000
BSI-free days	0.000	0.999	0.998	0.999
Comorbidities	0.034	1.2	1.01	1.5
Diabetic	0.9	0.9	0.5	1.7

	p	HR (Hazard ratio)	95.0% CI for HR
	p	HR (Hazard ratio)	Lower	Upper
Age	0.04	1.04	1.02	1.07
Initial creatinine	0.6	0.979	0.90	1.07
Initial PTH	0.2	0.999	0.998	1.000
Hospital admission	0.6	0.998	0.992	1.005
Peritonitis-free days	0.002	0.997	0.996	0.999

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[1] Correspondence to: Carolina Aparecida de Almeida Vicentini. E-mail: carolina.aparecida@unesp.br