A prospective, randomized, multicenter, open-label trial comparing survival in subjects receiving peritoneal dialysis or conventional in-center hemodialysis

Abstract

Background

Peritoneal dialysis (PD) and conventional in-center hemodialysis (HD) are treatment options for patients with end-stage kidney disease (ESKD). However, their impact on all-cause mortality is unclear.

Methods

We conducted a multicenter, open-label, randomized, non-inferiority trial to determine the effect of dialysis modality on mortality in patients with ESKD. Eligible patients were recruited from 30 sites across China and assigned to receive either PD or HD in a ratio of 1:1. The primary outcome was all-cause mortality. Non-inferiority was defined as the upper bound of the one-sided 95% confidence interval (CI) for the hazard ratio (HR) being ≤1.25.

Results

A total of 414 patients with incident ESKD were randomly assigned to PD (n = 213) or HD (n = 201). During a median follow-up of 1.7 years, 37 patients in the PD group and 31 in the HD group died, giving respective event rates per patient-year of 0.061 and 0.071. The HR for mortality on PD in comparison with HD was 0.76 (95% CI 0.47–1.24) after adjustment for age, sex, and diabetes status, achieving the limit for non-inferiority. There were more adverse events (p = 0.003), serious adverse events (p = 0.009), and adverse events leading to hospitalization (p = 0.003) in the PD group than in the HD group; however, there was no significant between-group difference in adverse events leading to death or discontinuation of treatment.

Conclusions

PD was non-inferior to conventional in-center HD in terms of survival in patients with ESKD. Our findings underscore the need for shared decision-making between physicians and patients regarding the selection of dialysis modality.

Trial registration

Registered at ClinicalTrials.gov (NCT01413074).