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Sudden Death in End Stage Renal Disease: Comparing Hemodialysis versus Peritoneal Dialysis
Simonetta Genovesi1, Luca Porcu, Maria Carmen Luise
1Nephrology Unit, San Gerardo Hospital, Monza, Italy.
Insights
Hemodialysis (HD) patients have more comorbidities and lower survival than peritoneal dialysis (PD) patients. However, sudden death (SD) risk is similar between HD and PD, with age and heart conditions predicting mortality.
Area of Science:
- Nephrology
- Cardiology
- Public Health
Background:
- Dialysis patients face significant mortality risks.
- Comparing outcomes between hemodialysis (HD) and peritoneal dialysis (PD) is crucial.
- Understanding predictors of total and sudden death (SD) is essential for patient care.
Purpose of the Study:
- To evaluate and compare total mortality and sudden death (SD) rates in hemodialysis (HD) versus peritoneal dialysis (PD) patients.
- To identify risk factors associated with mortality and SD in dialysis cohorts.
- To assess the comparative survival benefits of HD and PD.
Main Methods:
- Multicenter retrospective cohort study.
- Involved analysis of 1,823 HD patients and 249 PD patients.
- Statistical analysis to compare mortality and identify predictors.
Main Results:
- HD patients exhibited more comorbidities and lower survival rates than PD patients (p < 0.001).
- Mortality predictors included low left ventricular ejection fraction (LVEF) ≤35%, older age, ischemic heart disease, diabetes, stroke, and atrial fibrillation.
- Sudden death (SD) incidence did not significantly differ between HD and PD, with predictors including older age, ischemic heart disease, and LVEF ≤35%.
Conclusions:
- Hemodialysis (HD) patients present with more comorbidities and reduced survival compared to peritoneal dialysis (PD) patients.
- Despite survival differences, the incidence of sudden death (SD) was comparable between HD and PD populations.
- Key mortality predictors in dialysis patients involve cardiac function, age, and specific comorbidities.
Background/Aims:
This study aimed to evaluate total and sudden death (SD) in a cohort of dialysis patients, comparing hemodialysis (HD) vs. peritoneal dialysis (PD).
Methods:
This is a multicenter retrospective cohort study.
Results:
Deaths were 626 out of 1,823 in HD and 62 of 249 in PD patients. HD patients had a greater number of comorbidities (p < 0.05). PD patients had a lower risk of death than HD patients (p < 0.001); however, the advantage decreased with time (p < 0.001). Mortality predictors were left ventricular ejection fraction (LVEF) ≤35%, older age, ischemic heart disease, diabetes mellitus, previous stroke, and atrial fibrillation (p < 0.03). SDs were 84:71 in HD and 13 in PD population (12.1 and 22.8% of all causes of death, respectively). A non-significant risk of SD among PD compared to HD patients was detected. SD predictors were older age, ischemic heart disease, and LVEF ≤35% (p < 0.05).
Conclusions:
HD patients showed a greater presence of comorbidities and reduced survival compared to PD patients; however, the incidence of SD does not differ in the 2 populations. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=464347.