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Survival differences between peritoneal dialysis and hemodialysis among "large" ESRD patients in the United States
Austin G Stack1, Bhamidipati V R Murthy, Donald A Molony
1Division of Renal Diseases and Hypertension, Department of Internal Medicine, University of Texas Health Sciences Center at Houston, 77030, USA. Austin.Stack@uth.tmc.edu
Background:
It has been hypothesized that peritoneal dialysis compared to hemodialysis may be less effective in large patients with end-stage renal disease (ESRD).
Methods:
We tested this hypothesis in a cohort of 134,728 new ESRD patients who were initiated on dialysis from May 1, 1995 to July 31, 1997 using data from United States Renal Data System (USRDS). Cox regression models evaluated the association of body mass index (BMI) in quintiles (8.8-20.9, 20.9-23.5, 23.5-26.1, 26.1-30.0, 30.0-75.2 kg/m(2)) with mortality over 2 years in peritoneal dialysis and hemodialysis patients separately, while time-dependent models evaluated the relative risk (RR) of death by modality for each BMI quintile.
Results:
For hemodialysis, the adjusted RR of death was greatest for patients with BMI
Conclusion:
We conclude that body size modifies the impact of dialysis modality on mortality risk among new ESRD patients in the United States. The selection of hemodialysis over peritoneal dialysis was associated with a survival advantage in patients with large body habitus.
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