[Renaliste] Pour changer de l'emla et préparer la rentrée ... qui sera chaude j'espére

[BURTEY Stéphane]

Annals internal medicine


   Comparing the Risk for Death with Peritoneal Dialysis and
   Hemodialysis in a National Cohort of Patients with Chronic Kidney
   Disease

Bernard G. Jaar, MD, MPH; Josef Coresh, MD, PhD; Laura C. Plantinga,
ScM; Nancy E. Fink, MPH; Michael J. Klag, MD, MPH; Andrew S. Levey, MD;
Nathan W. Levin, MD; John H. Sadler, MD; Alan Kliger, MD; and Neil R.
Powe, MD, MPH, MBA

* 2 August 2005 | Volume 143 Issue 3 | Pages 174-183*

*Background: * The influence of type of dialysis on survival of^
patients with end-stage renal disease (ESRD) is controversial.^

*Objective: * To compare risk for death among patients with ESRD^ who
receive peritoneal dialysis or hemodialysis.^

*Design: * Prospective cohort study.^

*Setting: * 81 dialysis clinics in 19 U.S. states.^

*Patients: * 1041 patients starting dialysis (274 patients receiving^
peritoneal dialysis and 767 patients receiving hemodialysis)^ at baseline.^

*Measurements: * Patients were followed for up to 7 years and^ censored
at transplantation or loss to follow-up. Cox proportional^ hazards
regression stratified by clinic was used to compare^ the risk for death
with peritoneal dialysis versus hemodialysis.^

*Results: * Twenty-five percent of patients undergoing peritoneal^
dialysis and 5% of hemodialysis patients switched type of dialysis.^
After adjustment, the risk for death did not differ between^ patients
undergoing peritoneal dialysis and those undergoing^ hemodialysis during
the first year (relative hazard, 1.39 [95%^ CI, 0.64 to 3.06]), but the
risk became significantly higher^ among those undergoing peritoneal
dialysis in the second year^ (relative hazard, 2.34 [CI, 1.19 to 4.59]).
After stratification,^ the survival rate was no different for patients
who had the^ highest propensity of being initially treated with
peritoneal^ dialysis. Results were consistent with adjustment based on
a^ propensity score model and in sensitivity analyses that used^
as-treated models and models in which switches in type of dialysis^ were
treated as treatment failures. Results were similar but^ stronger in
analyses that were restricted to patients who were^ treated only in
clinics offering both types of dialysis.^

*Limitations: * Patients were not randomly assigned to their initial^
type of dialysis. Also, more patients undergoing peritoneal^ dialysis
than hemodialysis switched type of dialysis over time,^ and the reason
for switching was often a consequence of the^ technique.^

*Conclusions: * The risk for death in patients with ESRD undergoing^
dialysis depends on dialysis type. Further studies are needed^ to
evaluate a possible survival benefit of a timely change from^ peritoneal
dialysis to hemodialysis.^