Comparison of mortality risk by choice of CAPD versus hemodialysis among elderly patients

To evaluate patient survival among geriatric patients by dialytic treatment of choice we assigned all patients aged 65 years and older treated in Michigan to either CAPD at home or center hemodialysis (HD) according to the treatment used on day 120 of ESRD therapy. Michigan Kidney Registry files on all 308 CAPD and 1244 HD patients who started ESRD therapy during 1980-1987 were used for this study. The Cox proportional hazards model revealed a significantly increased relative death rate (RR) for patients with diabetes (RR = 1.91, p less than 0.001) and hypertension (RR 1.4, p less than 0.01) as cause of ESRD when adjusting for age, sex, race, treatment and year of incidence. White patients had a 51% higher relative death rate overall when compared to black patients (p less than 0.001) and specifically among hypertensive (RR = 1.65, p less than 0.001) and diabetic patients (RR = 1.59, p less than 0.001). Those differences were still significant when taking higher rates of withdrawal from dialysis among white patients into account. The relative death rates for CAPD patients was essentially the same as for HD patients overall, however, diabetic CAPD patients appeared to have a higher than diabetic HD patients (RR = 1.58, p = 0.1). This statistically not significant difference may be related to selection of patients with cardiovascular risk into CAPD. There was no trend in mortality over time. By modality on day 120, CAPD has similar outcomes as HD in geriatric non diabetic patients.