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Abstract: TH-PO979

Impacts of Conventional In-Center Hemodialysis and Peritoneal Dialysis on All-Cause Mortality in Patients With ESKD: A Randomized Controlled Trial With 10-Year Follow-Up

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

  • Yu, Xueqing, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Guangzhou, China
  • Fan, Li, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Guangzhou, China
  • Li, Jie, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Guangzhou, China
  • Zou, Xia, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Science, Guangzhou, China

Group or Team Name

  • The SURIND and China Q study investigators
Background

Conventional in-center hemodialysis (HD) and peritoneal dialysis (PD) are treatment options for patients with end-stage kidney disease (ESKD). However, their long-term impacts on all-cause mortality of patients with ESKD have not been determined.

Methods

This was a open-label, randomized trial form 36 sites in China, with 1082 incident ESKD patients randomly assigned to either HD or PD. The primary outcome was all-cause mortality, and was assessed in the intention-to-treat (ITT) population, with sensitivity analyses in the per-protocol and actual treatment datasets. We calculated the difference in restricted mean survival time (RMST) to compare the impacts of HD and PD on all-cause death (NCT01413074 and 02378350).

Results

537 ESKD patients allocated to HD and 545 to PD between June 2011 to July 2016. The mean (SD) age was 49.8 (14.9) years; 232 (21.4%) had diabetes and 158 (14.6%) had pre-existing cardiovascular disease. During a median follow-up of 3.1 (IQR 1.0–5.8) years, 122 (22.7%) patients in HD and 157 (28.8%) in PD group died. Survival was not different between HD and PD during the overall follow-up period after adjustment for age, sex, diabetes, and baseline eGFR (adjusted RMST difference 0.45[95% CI -0.39–1.30] years, P=0.29). However, the survival curves of HD and PD separated after 4-year follow-up. During the first 4 years after randomization, patients received HD and PD had comparable survival (adjusted RMST difference -0.03 [95% CI -0.16–0.10] years, P=0.65). In contract, patients with HD had better survival than those with PD in the last 6 years of follow-up (adjusted RMST difference 0.70 [0.05–1.34] years, P=0.03). HD was superior to PD in the patients without diabetes (adjusted RMST difference 0.49 [0.16–0.82] years, P=0.004) or cardiovascular diseases (adjusted RMST difference 0.51 [0.23–0.80] years, P<0.001). PD patients with cardiovascular disease had better survival than HD, although the RMST difference was not significant. The result of the sensitivity analyses were consistent.

Conclusion

HD and PD had comparable survival in ESKD patients during the overall follow-up period and the first 4 years of treatment, but HD was superior to PD afterword. Our findings are essential for decision making in choosing the optimal dialysis modality in ESKD patients.

Funding

  • Commercial Support