Aims Despite several studies reporting similar outcomes for peritoneal dialysis (PD) and hemodialysis (HD), the former is underused worldwide, with a PD prevalence of 15% in Italy. In 2008, the Unit of Nephrology and Dialysis of the Healthcare Trust of the Autonomous Province of Trento implemented a successful PD program which has increased the proportion of PD incident patients from 7 to 47%. We aimed to assess the efect of this extensive use of PD by comparing HD and PD in terms of survival and time-to-transplantation. Methods A total of 334 HD and 153 PD incident patients were enrolled between January 2008 and December 2014. After screening for exclusion criteria and propensity score matching, 279 HD and 132 PD patients were analyzed. Survival and time-to-transplantation were assessed by competing-risks regression models, using death and transplantation as primary and competing events. Results Crude and adjusted regression models for survival revealed the absence of signiicant diferences between HD and PD cumulative incidence functions (subhazard ratio: 1.09, p = 0.62 and 1.34, p = 0.10, respectively). Diferently, crude and adjusted regression models for transplantation revealed a lower time-to-transplantation for PD versus HD patients (subhazard ratio: 2.34, p < 0.01, and 2.57, p < 0.01, respectively). The waiting time for placement in the transplant waiting list was longer in HD than PD patients (330 vs. 224 days, p < 0.01). Conclusions The extensive use of PD did not lead to any statistically signiicant diference in mortality. Furthermore, PD was associated with lower time to transplantation. PD may be a viable option for large-scale dialytic reatment in the advanced chronic kidney disease population.

Survival and time-to-transplantation of peritoneal dialysis versus hemodialysis for end-stage renal disease patients: competing-risks regression model in a single Italian center experience / M. Rigoni, E. Torri, G. Nollo, D. Zarantonello, A. Laudon, L. Sottini, G.M. Guarrera, G. Brunori. - In: JN. JOURNAL OF NEPHROLOGY. - ISSN 1121-8428. - 30:3(2017), pp. 441-447. [10.1007/s40620-016-0366-6]

Survival and time-to-transplantation of peritoneal dialysis versus hemodialysis for end-stage renal disease patients: competing-risks regression model in a single Italian center experience

M. Rigoni
Primo
;
2017

Abstract

Aims Despite several studies reporting similar outcomes for peritoneal dialysis (PD) and hemodialysis (HD), the former is underused worldwide, with a PD prevalence of 15% in Italy. In 2008, the Unit of Nephrology and Dialysis of the Healthcare Trust of the Autonomous Province of Trento implemented a successful PD program which has increased the proportion of PD incident patients from 7 to 47%. We aimed to assess the efect of this extensive use of PD by comparing HD and PD in terms of survival and time-to-transplantation. Methods A total of 334 HD and 153 PD incident patients were enrolled between January 2008 and December 2014. After screening for exclusion criteria and propensity score matching, 279 HD and 132 PD patients were analyzed. Survival and time-to-transplantation were assessed by competing-risks regression models, using death and transplantation as primary and competing events. Results Crude and adjusted regression models for survival revealed the absence of signiicant diferences between HD and PD cumulative incidence functions (subhazard ratio: 1.09, p = 0.62 and 1.34, p = 0.10, respectively). Diferently, crude and adjusted regression models for transplantation revealed a lower time-to-transplantation for PD versus HD patients (subhazard ratio: 2.34, p < 0.01, and 2.57, p < 0.01, respectively). The waiting time for placement in the transplant waiting list was longer in HD than PD patients (330 vs. 224 days, p < 0.01). Conclusions The extensive use of PD did not lead to any statistically signiicant diference in mortality. Furthermore, PD was associated with lower time to transplantation. PD may be a viable option for large-scale dialytic reatment in the advanced chronic kidney disease population.
Advanced chronic kidney disease; Competing-risks model; Dialysis survival; Hemodialysis; Kidney transplantation; Peritoneal dialysis
Settore MED/01 - Statistica Medica
2017
http://link.springer.com/article/10.1007/s40620-016-0366-6
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/936610
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