Dialysis modality and survival: does the controversy live on?

Current Opinion in Nephrology and Hypertension
Asad Ali MerchantJeffrey Perl

Abstract

Continued debate regarding the relative mortality risk for end-stage renal disease patients treated with either peritoneal dialysis or facility-based three times weekly conventional haemodialysis (CHD) stems from the absence of adequately powered randomized controlled trials, and the reliance on observational studies. These reports have yielded important trends, but also conflicting results. Here, we summarize the contemporary literature on survival comparisons between CHD and peritoneal dialysis, highlighting trends and important differences between studies. Large observational studies have not conclusively shown an overall survival advantage of either dialysis modality. Studies have consistently shown an early survival advantage for peritoneal dialysis relative to CHD. New insights including accounting for selection bias and the use of central venous catheters as incident haemodialysis access may explain much of this apparent early mortality difference. The relative mortality risk of peritoneal dialysis versus haemodialysis may be decreasing in more contemporary cohorts. Older patients, diabetic patients, and those with comorbidities may have a relatively worse prognosis on peritoneal dialysis compared to CHD. Overall, surviv...Continue Reading

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Citations

Feb 26, 2016·Clinical Journal of the American Society of Nephrology : CJASN·Martin B Lee, Joanne M Bargman
Feb 28, 2017·Nature Reviews. Nephrology·Kristina N EkdahlBo Nilsson
Mar 15, 2018·Seminars in Dialysis·Emilie TrinhJeffrey Perl
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Apr 22, 2017·Kidney Research and Clinical Practice·Hyunwook Kim, Dong-Ryeol Ryu
Jun 5, 2021·Nucleosides, Nucleotides & Nucleic Acids·Claudia Diez-LopezMariano Andres

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