Peritoneal dialysis has lower mortality risk compared to hemodialysis due to cen

[okarol]

Peritoneal dialysis has lower mortality risk compared to hemodialysis due to central catheters
4/22/2011

New data suggest that the higher early survival rate for patients on peritoneal dialysis compared to hemodialysis patients might be explained by a higher risk of early deaths among patients undergoing hemodialysis with central venous catheters, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology.
 
In a study that included more than 38,500 Canadian patients starting dialysis between 2001 and 2008, 63% started hemodialysis using a central catheter placed into one of the large veins. Seventeen percent started hemodialysis with an arteriovenous fistula or arteriovenous graft. The remaining 19% started on peritoneal dialysis.   

Those patients who had an arteriovenous fistula or graft when starting hemodialysis showed similar survival rates to the patients on peritoneal dialysis.

"Our results emphasize the importance of predialysis care and education, and the need to avoid central venous catheter use in our hemodialysis patients," comments Jeffrey Perl, MD, from St Michael's Hospital, Toronto.
 
During the first year, the risk of death for patients starting hemodialysis with a central catheter was 80% higher than for patients who started on peritoneal dialysis. The risk of death in the first year for patients who started hemodialysis with an arteriovenous fistula or graft was similar to that of the peritoneal dialysis 
 
In the five years after starting dialysis, the risk of death was still 20% higher in patients who started hemodialysis with a central catheter, compared to the peritoneal dialysis group. The survival rate for patients who started hemodialysis with an arteriovenous fistula or graft remained similar to that for patients who started on peritoneal dialysis.
 
Some past studies have shown that patients on peritoneal dialysis   are at lower risk of death during the first year or two on dialysis, compared to patients on hemodialysis. "However, these studies have been heavily criticized for comparing 'apples to oranges,'" says Perl. "Their results may speak more towards the type of patients selected for peritoneal dialysis  over hemodialysis rather than a direct impact of peritoneal dialysis versus hemodialysis itself on patient survival."

Perl said believes the new study provides a more fair, "apples to apples?? comparison of peritoneal dialysis  patients versus hemodialysis patients who have been "optimally prepared" with an AVF/AVG.

The study is limited by the fact it was an observational study, rather than a randomized controlled trial. Information on the type of access for hemodialysis use was obtained only at the time of dialysis initiation. Information on follow-up vascular access was not available, which would be useful to understand the contribution of the catheter versus other factors contributing to risk of death. There was no information on the reasons why patients started hemodialysis with a central catheter, or on whether they started dialysis in the hospital or as an outpatient.
 
 
The article entitled, ?Hemodialysis Vascular Access Modifies the Association between Dialysis Modality and Survival,? appears online at http://jasn.asnjournals.org.