Clinical outcomes by dialysis modality in patients with end stage renal disease

The prevalence of hemodialysis (HD) and peritoneal dialysis (PD) as a treatment modality for end-stage renal disease (ESRD) varies among countries and is affected by non-clinical factors including insurance, the health care system, and the preferences for treatment providers rather than clinical factors. There are pros and cons to both modalities. So far, since no randomized controlled trials have succeeded in revealing which dialysis modality is better, knowledge on clinical outcomes in patients with ESRD by dialysis modality is based on the results from multicenter prospective observational studies and large-scale national registry data in each country. In prospective cohort studies in the 1990's, HD showed similar or higher mortality than PD during the first year, but PD showed higher mortality after the first year. Meanwhile, clinical outcomes of dialysis patients resulting from national registry data in the 1990's were similar for PD and HD. From national registry data after 2000, the survival of patients on both HD and PD improved rapidly. This improvement was much greater in PD, especially in the early period after initiation of dialysis. Non-diabetic patients less than 65 years old showed better outcomes with PD than HD, whereas diabetic patients aged more than 65 years old (especially females) showed better outcomes with HD than PD. A higher risk of death in diabetic PD patients, though still present in the most recent cohorts, has been progressively attenuated over time in recent cohorts.