Hemodialysis Leads to Better Survival in Patients with Diabetes or High Comorbidity, Compared to Peritoneal Dialysis

Peritoneal dialysis (PD) has some advantages, such as hemodynamic stability and volume regulation, compared with hemodialysis (HD). However, the influence of the dialysis modality on survival is still controversial. This study assessed the mortality of incident patients undergoing HD versus PD using a propensity score approach. This study enrolled 873 subjects who began dialysis therapy at Gachon University Gil Hospital in Korea between January 2000 and June 2009. A propensity score comprising demographic, clinical, and laboratory variables was used to select a 1:1 matched cohort. The overall 1-, 2-, 3-, and 5-year survival rates for the HD patients (n = 212) were 95.1, 89.6, 82.5, and 65.3%, respectively, whereas the equivalent survival rates for the PD patients (n = 212) were 93.6, 83.1, 73.9, and 48.4%, respectively (P = 0.002 by log rank test). In patients without diabetes or patients with a low modified Charlson comorbidity index (MCCI), including hypertension, cardiovascular disease, liver disease, etc., there was no difference in mortality between PD and HD. However, PD was associated with a higher mortality for diabetic patients (HR, 2.86; 95% CI, 1.73-4.74) and for patients with a high MCCI (HR, 2.54; 95% CI 1.57-4.10). These data suggest that survival for PD may be comparable with that for HD in incident dialysis patients without diabetes or high MCCI and that HD could be more beneficial in patients with diabetes or high MCCI in this propensity score-matched cohort.