Comparative study of peritoneal dialysis versus hemodialysis on the clinical outcomes in Korea: a population-based...

Area of Science:

• Nephrology
• Public Health
• Epidemiology

Background:

• Limited data exists on the comparative trends of adverse outcomes between peritoneal dialysis (PD) and hemodialysis (HD) in Korea.
• Understanding these trends is crucial for optimizing renal replacement therapy strategies.

Purpose of the Study:

• To investigate the secular trends of mortality and nonfatal cardiovascular events (CVEs) comparing PD and HD in a large Korean cohort.
• To assess the evolving risk associated with PD relative to HD over time.

Main Methods:

• Utilized the National Health Insurance Service database to identify 96,596 patients initiating dialysis between 2004 and 2015 in Korea.
• Employed survival analysis to calculate adjusted hazard ratios (HR) for mortality and CVEs, comparing PD to HD across different time periods (2004-2007, 2008-2011, 2012-2015).
• Conducted subgroup analyses based on age, diabetes, and comorbidity burden, and evaluated censoring at different follow-up durations (1, 3, and 5 years).

Main Results:

• The adjusted HR for mortality of PD over HD was significant in 2004-2007 (1.31) and 2008-2011 (1.21), but became insignificant in 2012-2015.
• A similar trend of improvement was observed for nonfatal CVEs.
• In 2012-2015, the mortality risk of PD over HD was insignificant with 1-year censoring but became significant with 3- or 5-year censoring.

Conclusions:

• The comparative mortality risk associated with peritoneal dialysis versus hemodialysis in Korea has significantly improved over the study period.
• This improvement in PD outcomes is mirrored by advancements in nonfatal cardiovascular event rates.
• The findings suggest a positive secular trend in PD outcomes, potentially influenced by evolving treatment protocols and patient management.