Patients who transition to peritoneal dialysis (PD) or home hemodialysis (HHD) within a year of starting dialysis with another modality have similar early risk of death, including from cardiovascular and infectious causes, investigators reported in the American Journal of Nephrology.

Patients who transition to PD after 1 year, however, appear to have worse survival than their counterparts.  

Kamyar Kalantar-Zadeh, MD, PhD, MPH, of the University of California Irvine, and colleagues propensity score matched (by demographics, comorbidities, duration of dialysis, and body mass index) 1915 HHD patients with 1915 PD patients who initiated renal replacement therapy during 2007 to 2011. They grouped patients by dialysis vintage at the time of home dialysis transition: less than 3, 3 or more but less than 12, and 12 or more months.

In the entire matched cohort, 237 HHD and 359 PD patients died, or 9.6 vs 12.9 deaths per 100 patient-years, respectively. PD patients with early transition to home dialysis (within the first 12 months), however, did not have significantly different mortality risk compared with their HHD counterparts, whereas PD patients who transitioned more than 12 months later had an 83% higher mortality risk. Overall, similar proportions of both groups transferred to in-center HD: 17 vs 17.2 per 100 person-years of the HHD and PD groups, respectively. More HHD patients underwent transplantation, however: 8.7 vs 5.6 per 100 person-years, respectively.

“PD is internationally less costly compared with in-center HD, and is cost effective even if patients revert to in-center HD due to technical failure within 1 year. Therefore, our results suggest we have to focus on non-inferiority of PD within early transition (within 12 months) rather than HHD superiority beyond 12 months of vintage,” Dr Kalantar-Zadeh’s team stated.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Reference

Choi SJ, Obi Y, Kodoi GJ, et al. Comparing patient survival of home hemodialysis and peritoneal dialysis patients [published online January 28, 2020]. Am J Nephrol. doi: 10.1159/000504691