J Korean Med Sci.  2012 Feb;27(2):170-176. 10.3346/jkms.2012.27.2.170.

Outcome of Early Initiation of Peritoneal Dialysis in Patients with End-Stage Renal Failure

• Oh KH
• Hwang YH
• Cho JH
• Kim M
• Ju KD
• Joo KW
• Kim DK
• Kim YS
• Ahn C
• Oh YK

• KMID: 1120154
• DOI: http://doi.org/10.3346/jkms.2012.27.2.170

Abstract

Recent studies reported that early initiation of hemodialysis may increase mortality. However, studies that assessed the influence of early initiation of peritoneal dialysis (PD) yielded controversial results. In the present study, we evaluated the prognosis of early initiation of PD on the various outcomes of end stage renal failure patients by using propensity-score matching methods. Incident PD patients (n = 491) who started PD at SNU Hospital were enrolled. The patients were divided into 'early starters (n = 244)' and 'late starters (n = 247)' on the basis of the estimated glomerular filtration rate (eGFR) at the start of dialysis. The calculated propensity-score was used for one-to-one matching. After propensity-score-based matching (n = 136, for each group), no significant differences were observed in terms of all-cause mortality (P = 0.17), technique failure (P = 0.62), cardiovascular event (P = 0.96) and composite event (P = 0.86) between the early and late starters. Stratification analysis in the propensity-score quartiles (n = 491) exhibited no trend toward better or poorer survival in terms of all-cause mortality. In conclusion, early commencement of PD does not reduce the mortality risk and other outcomes. Although the recent guidelines suggest that initiation of dialysis at higher eGFR, physicians should not determine the time to initiate PD therapy simply rely on the eGFR alone.

Keyword

Peritoneal Dialysis; End Stage Renal Failure; Dialysis Initiation; Propensity Score Match; Outcome; Survival

MeSH Terms

Adult
Aged
Female
Glomerular Filtration Rate
Humans
Kidney Failure, Chronic/*mortality/therapy
Male
Middle Aged
*Peritoneal Dialysis
Prognosis
Propensity Score
Proportional Hazards Models
Retrospective Studies
Survival Rate
Treatment Outcome

Figure

• 

  Fig. 1 Primary and secondary outcomes of early and late starters of peritoneal dialysis adjusted by start age, sex, body mass index, albumin, hemoglobin, hsCRP, diabetes, congestive heart failure, malignancy, peripheral artery disease, ischemic heart disease, collagen disorder, and education level. (A) All-cause mortality (P = 0.17). (B) Technique failure (P = 0.62). (C) Cardiovascular event (P = 0.96). (D) Composite event (P = 0.86) free survival.

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