Related Experiment Video
Updated: Jun 20, 2026
Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
Association of dialysis modality and cardiovascular mortality in incident dialysis patients
David W Johnson1, Hannah Dent, Carmel M Hawley
1Australia and New Zealand Dialysis and Transplant Registry, Adelaide, South Australia, Australia. david_johnson@health.qld.gov.au
Insights
Patients on peritoneal dialysis (PD) face a higher risk of cardiovascular death compared to those on hemodialysis (HD). This increased risk, particularly from myocardial infarction, highlights differences in cardiovascular outcomes between dialysis modalities.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Epidemiology
Background:
- End-stage renal disease (ESRD) patients have a high burden of cardiovascular disease.
- Dialysis modality (peritoneal dialysis vs. hemodialysis) may influence cardiovascular outcomes.
Purpose of the Study:
- To compare rates, causes, and timing of cardiovascular death between incident peritoneal dialysis (PD) and hemodialysis (HD) patients.
Main Methods:
- Analysis of Australian and New Zealand incident dialysis patients (1997-2007).
- Comparison of cardiovascular death rates using incident rate ratios and Cox proportional hazards models.
- Inclusion of dialysis modality as a time-varying covariate and use of competing risks approach.
Main Results:
- Of 24,587 patients, 5669 (21%) died from cardiovascular causes.
- Cardiovascular mortality incidence rates were higher in PD (9.99/100 patient-years) versus HD (7.96/100 patient-years).
- Peritoneal dialysis was associated with increased hazard of cardiovascular death, primarily due to myocardial infarction.
Conclusions:
- Dialysis modality significantly impacts the risk, causes, and timing of cardiovascular death in ESRD patients.
- Peritoneal dialysis patients exhibit a higher risk of cardiovascular mortality compared to hemodialysis patients.
Background And Objectives:
The aim of the investigation presented here was to compare the rates, causes, and timing of cardiovascular (CV) death in incident peritoneal dialysis (PD) and hemodialysis (HD) patients.
Design, Setting, Participants, & Measurements:
The study included all adult Australian and New Zealand patients commencing dialysis between January 1, 1997 and December 31, 2007. Rates of and times to CV death were compared by incident rate ratios, cumulative incidence, and multivariable Cox proportional hazards model analyses. Dialysis modality was included in the model as a time-varying covariate, and a competing risks approach was used to obtain cause-specific hazard ratios.
Results:
Of the 24,587 patients who commenced dialysis (first treatment PD n = 6521; HD n = 18,066) during the study, 5669 (21%) died from CV causes [PD 2044 (28%) versus HD 3625 (21%)]. The incidence rates of CV mortality in PD and HD patients were 9.99 and 7.96 per 100 patient-years, respectively (incidence rate ratio PD versus HD, 1.25; 95% confidence interval 1.12 to 1.32). PD was consistently associated with an increased hazard of CV death compared with HD after 1 yr of treatment. This increased risk in PD patients was largely accounted for by an increased risk of death due to myocardial infarction.
Conclusions:
Dialysis modality is significantly associated with the risk, causes, and timing of CV death experienced by ESRD patients in Australia and New Zealand.
Related Concept Videos
01:27Dialysis
Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
01:15Dialysis
01:24Hemodialysis II: Procedure and Complications
01:25Hemodialysis I: Introduction
01:25Hemodialysis III: Nursing Management
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications