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Dialysis Modality and Mortality in the Elderly: A Meta-Analysis.

Seung Seok Han1, Jae Yoon Park1, Soohee Kang2

  • 1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea;

Clinical Journal of the American Society of Nephrology : CJASN
|May 6, 2015
PubMed
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For elderly patients with end-stage renal disease (ESRD), hemodialysis (HD) is associated with a lower mortality risk compared to peritoneal dialysis (PD). This finding was consistent in both Korean patients and a broader meta-analysis, particularly for those with diabetes or longer dialysis durations.

Area of Science:

  • Nephrology
  • Geriatric Medicine
  • Public Health

Background:

  • Choosing between hemodialysis (HD) and peritoneal dialysis (PD) for elderly patients with end-stage renal disease (ESRD) remains a challenge.
  • Elderly ESRD patients face high mortality risks and limited kidney transplant options.

Purpose of the Study:

  • To compare the mortality rates between HD and PD in elderly patients with ESRD.
  • To evaluate the impact of comorbidities and dialysis duration on survival outcomes.

Main Methods:

  • Analysis of data from 13,065 incident dialysis patients (age ≥65) in Korea (HD vs. PD).
  • Utilized multivariate Cox models and meta-analysis of 15 prior studies (>631,421 patients).

Main Results:

Keywords:
dialysis modalityelderlyhemodialysismortalityperitoneal dialysis

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  • Korean PD patients showed a higher mortality rate (HR 1.20) than HD patients.
  • Meta-analysis revealed a pooled HR of 1.10 for PD versus HD.
  • Hemodialysis offered a survival benefit, especially for patients with diabetes, longer dialysis duration, or those starting dialysis in the 1990s.

    • Conclusions:

    • A comprehensive meta-analysis including Korean data indicates a higher mortality risk for elderly patients on PD compared to HD.
    • Hemodialysis may be a preferable dialysis modality for elderly ESRD patients, particularly those with specific risk factors.