Type of dialysis makes a difference to death risk

For people with end-stage renal disease, those on hemodialysis tend to live longer than those who opt for peritoneal dialysis, according to a new report.

When kidneys fail, toxins in a patient’s blood can be removed by passing the blood over membranes that allow the harmful substances to pass through and be removed. An alternative to hemodialysis is peritoneal dialysis, a process in which fluid is instilled into the abdominal cavity and then drained after several hours, along with unwanted toxins.

The advantage of peritoneal dialysis is that the patient is not tethered to a machine for hours at a time.

“Peritoneal dialysis should remain a good initial dialysis treatment option for many patients,” said Dr. Bernard G. Jaar from Johns Hopkins University, Baltimore, Maryland. “However, nephrologists should follow these peritoneal dialysis patients closely and consider a timely switch to hemodialysis when peritoneal dialysis related complications arise.”

Jaar and colleagues compared the risk of dying among 1041 patients with kidney failure who were followed for an average of 2-1/2 years after starting hemodialysis (767 patients) or peritoneal dialysis (274 patients, who tended to be healthier than the hemodialysis patients).

The unadjusted mortality rate was lower for patients who had peritoneal dialysis (21.2 percent) than for patients who had hemodialysis (24.4 percent), the authors report in the Annals of Internal Medicine.

After adjustment for health status and various other factors, however, patients treated with peritoneal dialysis had a significant 2.34-fold higher mortality during the second year, compared with patients treated with hemodialysis.

“I think it’s important for nephrologists to continue to educate patients with end-stage kidney disease and to offer both types of dialysis,” Jaar said. “I believe that patients with less cardiovascular disease and those with residual urine output remain the best candidates for peritoneal dialysis,” he advised.

However, Dr. Gerald Schulman from Vanderbilt University School of Medicine, Nashville, Tennessee is less convinced about the advantages of one type of dialysis over the other. “The entire body of evidence is too inconsistent to draw any firm conclusion about the superiority of one form of dialysis,” he writes in a related commentary.

Schulman thinks the current study is basically out of date. “Its principal shortcoming is that it took aim at a moving target,” he says. “Fortunately for the growing number of patients with end stage renal disease, the technology of dialysis keeps advancing.”

SOURCE: Annals of Internal Medicine, August 2, 2005.

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