Long-Term Outcome Analysis of Peritoneal Dialysis and Hemodialysis in Patients With End-Stage Kidney Disease: A Real-World Data Analysis.

Abstract

Background: Despite extensive research on peritoneal dialysis (PD) and hemodialysis (HD), understanding long-term outcomes between these modalities remains limited. We conducted a retrospective cohort study to assess the clinical outcomes of PD and HD in a real-world context.

Methods: Utilizing the National Health Insurance Research Database in Taiwan, we studied patients who underwent dialysis from January 2006 to December 2017. Patients with a history of cancer, renal transplantation, age < 20 or > 84 years, or patients on PD who switched to HD within 3 months of starting the modality were excluded. They were categorized into three groups: HD-only (n = 59,751), PD-only (n = 3969), and PD-to-HD transition (n = 3196). Propensity score matching based on sex, age, and the Charlson comorbidity index was used to create comparable groups. Hazard ratios (HR) for clinical outcomes were calculated using the Cox regression model, comparing HD-only versus PD-only and the transition group outcomes. Follow-up continued until December 31, 2020. Finally, external validation was performed using the global TriNetX dataset.

Results: After 1:1 propensity score matching and multivariable adjustment, the HD-only group (n = 3969) exhibited significantly lower all-cause mortality and infection-related admissions compared to the PD-only group (n = 3969) (HRs 0.77 and 0.75, 95% CI: 0.72-0.83 and 0.70-0.80, respectively), with a survival advantage across most subgroups. Conversely, the PD-to-HD transition group (n = 2014) had worse hospitalization and major adverse cardiovascular event outcomes than those on PD-only (n = 2014) (HRs 1.83 and 1.22, 95% CIs: 1.71-1.97 and 1.10-1.36, respectively) but showed neutral mortality rates. A survival benefit emerged 2 years post-transition from PD to HD, with an HR of 0.62 (95% CI: 0.54-0.74). These findings were corroborated by the TriNetX data.

Conclusion: Our study indicates that HD patients tend to have better clinical outcomes, including greater longevity, compared to PD patients. Thus, the choice of dialysis modality should be tailored to individual patient needs for optimal outcomes.