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Dialysis Modality and Mortality in the Elderly: A Meta-Analysis

Title
Dialysis Modality and Mortality in the Elderly: A Meta-Analysis
Authors
Han, Seung SeokPark, Jae YoonKang, SooheeKim, Kyoung HoonRyu, Dong-RyeolKim, HyunwookJoo, Kwon WookLim, Chun SooKim, Yon SuKim, Dong Ki
Ewha Authors
류동열
SCOPUS Author ID
류동열scopus
Issue Date
2015
Journal Title
CLINICAL JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY
ISSN
1555-9041JCR Link1555-905XJCR Link
Citation
vol. 10, no. 6, pp. 983 - 993
Publisher
AMER SOC NEPHROLOGY
Indexed
SCIE; SCOPUS WOS scopus
Abstract
Background and objectives Identifying the appropriate choice between hemodialysis (HD) and peritoneal dialysis (PD) is an unresolved issue in elderly patients with ESRD, who are at high risk for death but have a low chance of receiving kidney transplantation. Design, setting, participants, & measurements Data on 13,065 incident dialysis Korean patients (age >= 65 years) receiving HD (n=10,675) or PD (n=2390) were obtained from the Korean Health Insurance dataset. Multiple statistical approaches, including the multivariate Cox model, were used to compare mortality between Korean patients receiving PD and those receiving HD. Subsequently, meta-analysis of previous comparison studies (published since the year 2000; population-based studies) and the Korean dataset was performed. Results During a mean duration of 1.8 +/- 1.3 years (maximum of 5 years), the Korean PD group had a higher mortality rate than the Korean HD group (hazard ratio [HR], 1.20 [95% confidence interval (95% CI), 1.13 to 1.28]; P<0.001 by multivariate Cox model). The discrepancy between the two modalities was greater in the presence of certain conditions, such as diabetes mellitus or longer dialysis duration. In the meta-analysis, 15 studies involving >631,421 elderly patients were reviewed. Compared with HD, the pooled HR with PD was 1.10 (95% CI, 1.01 to 1.20). When the meta-analysis was stratified by confounding factors, the survival benefit from HD was particularly strong in subgroups that had diabetes mellitus, had long dialysis duration (>1 year), or contained cohorts starting dialysis in the 1990s. Conclusions A meta-analysis that included results in Korean patients suggests a higher risk for death in elderly patients receiving PD than in those receiving HD.
DOI
10.2215/CJN.05160514
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의학전문대학원 > 의학과 > Journal papers
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