Abstract: TH-PO820

Early Mortality Comparison between Hemodialysis and Peritoneal Dialysis Patients Who Transition with an Optimal Outpatient Start

Session Information

Category: Dialysis

  • 607 Dialysis: Epidemiology, Outcomes, Clinical Trials - Non-Cardiovascular

Authors

  • Sim, John J., Kaiser Permanente Southern California, Pasadena, California, United States
  • Zhou, Hui, Kaiser Permanente Southern California, Pasadena, California, United States
  • Shi, Jiaxiao, Kaiser Permanente Southern California, Pasadena, California, United States
  • Shaw, Sally F., Kaiser Permanente Southern California, Pasadena, California, United States
  • Rasgon, Scott A., Kaiser Permanente Southern California, Pasadena, California, United States
  • Kovesdy, Csaba P., University of Tennessee Health Science Center, Memphis, Tennessee, United States
  • Kalantar-Zadeh, Kamyar, University of California Irvine, School of Medicine, Orange, California, United States
  • Jacobsen, Steven J., Kaiser Permanente Southern California, Pasadena, California, United States
Background

Lower early mortality observed in peritoneal dialysis (PD) compared to hemodialysis (HD) may be due to differential pre- end stage renal disease (ESRD) care and the stable setting of transition to dialysis. Specifically, PD starts occur more frequently in an outpatient setting rather than during a hospitalization. To account for these circumstances, we sought to compare early mortality among PD and HD patients who had optimal ESRD starts and first transitioned to dialysis on an outpatient basis.

Methods

A retrospective cohort study (1/1/2002-12/31/2013) within Kaiser Permanente Southern California (an integrated health system) was performed on chronic kideny disease patients who had optimal start transition to ESRD in an outpatient setting. Optimal start was defined as 1) initiation of HD with an arteriovenous fistula or graft or 2) initiation with PD. Propensity score modeling factoring sex, race, age, co morbidities, eGFR level, and change in eGFR prior to ESRD was used to create a matched cohort of HD and PD patients. All-cause mortality odds ratio (OR)’s were estimated for 6 months, 1 yr, and 2yr post transition to ESRD.

Results

A total of 2,094 (1398 HD and 696 PD) patients had an optimal outpatient transition to ESRD. The mean age was 62 yrs with 40% females, 39% Hispanics, 26% whites, and 21% blacks. In the 2 year observation window, 20% PD patients switched to HD while only 2% of HD patients switched to PD. 547 HD patients were matched to 547 PD patients on the propensity score with caliper distance <=0.001. All-cause mortality OR in HD compared to PD patients were 1.09 (0.47-2.57), 1.64 (0.92-2.93), and 0.90 (0.61-1.33) for 6 months, 1yr, and 2yrs, respectively. White race and age >/=60 yrs were associated with higher mortality.

Conclusion

There were no differences in early mortality between PD and HD patients who transitioned to ESRD with an optimal start in an outpatient setting. While prior observations have suggested an early survival advantage with PD, our finding suggest that the pre-ESRD care and the stable transition to dialysis likely account for lower early mortality among the ESRD population.

Funding

  • NIDDK Support