A comparison of cause of death between patients treated with hemodialysis and peritoneal dialysis.

Abstract

Mortality rates associated with peritoneal dialysis (PD) have been found to be higher than those associated with hemodialysis (HD) among prevalent U.S. patients over the age of 55 in the preceding study. Given the substantial technical differences between PD and HD, causes of death might also be expected to differ between these dialytic modalities. In order to help elucidate the relative contributions of these technical differences and to further the understanding of the excess mortality observed among PD-treated dialysis patients, this epidemiologic study compared cause of death in prevalent HD- and PD-treated patients in a large national sample, adjusting for demographic characteristics. Data for patients prevalent on January 1 of the years 1987, 1988, and 1989, each with 1 yr of follow-up, were obtained from the U.S. Renal Data System. Patients were censored at transplantation. Death rates per 100 patient years for seven cause-of-death categories were compared between HD and PD, adjusting for age, race, gender, cause of ESRD (diabetes versus nondiabetes), and < 1 yr or > 1 yr of prior ESRD, by use of the Poisson regression. There were 42,372 deaths occurring over 170,700 patient years at risk. There was a significantly increased mortality risk for PD compared with HD for all cause-of-death categories, except malignancy, for which there was a higher mortality risk for HD. The excess all-cause mortality observed in PD-treated patients can be accounted for, in decreasing order, by infection (35%), acute myocardial infarction (24%), other cardiac causes (16%), cerebrovascular disease (8%), withdrawal (8%), and malignancy (-6%).(ABSTRACT TRUNCATED AT 250 WORDS)