Highlights
- •Icodextrin could improve prognosis in peritoneal dialysis (PD) patients.
- •This study compared the survival between incident hemodialysis (HD) and PD patients.
- •Icodextrin attenuates the survival disadvantage of PD relative to HD in DM patients.
Abstract
Background
Icodextrin could reduce the risk of technique failure and improve patient survival
in peritoneal dialysis (PD) patients. This study compared the survival between incident
hemodialysis (HD) and PD patients, with and without diabetes, in the era of icodextrin
treatment.
Methods
From the Taiwan health insurance database, 53,103 incident end-stage renal disease
patients undergoing dialysis were identified from 2005 to 2010. The mortality risks
among HD and PD patients with or without icodextrin treatment were compared. The follow-up
period started from the date of dialysis initiation to December 31, 2011. The competing-risks
regression model was used to estimate the subhazard ratio (SHR) of death with considering
renal transplantation as a competing event.
Results
Compared with the corresponding HD patients, mortality risks were higher in diabetic
PD patients with icodextrin treatment (Bonferroni adjusted SHR = 1.16, 98.3% CI = 1.04–1.30) and without the treatment (Bonferroni adjusted SHR = 1.35, 98.3% CI = 1.16–1.57), particularly for elderly patients. Mortality risks for patients without
diabetes were not different among the three cohorts. The time-dependent competing-risks
model showed that PD patients with icodextrin treatment exhibited a reduced risk of
death for diabetic patients, compared with those without icodextrin treatment (adjusted
SHR = 0.84, 95% CI = 0.72–0.97).
Conclusions
Icodextrin could attenuate the survival disadvantage for PD relative to HD in diabetic
patients, particularly for the elderly patients.
Abbreviations:
AF (atrial fibrillation), APD (automated peritoneal dialysis), CAD (coronary artery disease), CHF (congestive heart failure), CI (confidence interval), COPD (chronic obstructive pulmonary disease), ESRD (end-stage renal disease), HD (hemodialysis), PS (propensity score), SHR (subhazard ratio), ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification), PD (peritoneal dialysis)Keywords
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Article info
Publication history
Published online: December 03, 2017
Accepted:
November 30,
2017
Received in revised form:
November 24,
2017
Received:
July 25,
2017
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
