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Comparison of survival between hemodialysis and peritoneal dialysis patients with end-stage renal disease in the era of icodextrin treatment

  • I-Kuan Wang
    Affiliations
    Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan

    Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
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  • Cheng-Li Lin
    Affiliations
    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    College of Medicine, China Medical University, Taichung, Taiwan
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  • Tzung-Hai Yen
    Affiliations
    Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan

    Chang Gung University College of Medicine, Taoyuan, Taiwan
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  • Shih-Yi Lin
    Affiliations
    Division of Kidney Disease, China Medical University Hospital, Taichung, Taiwan
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  • Fung-Chang Sung
    Correspondence
    Correspondence to: F-C. Sung, Graduate Institute of Clinical Medical Science and Department of Health Services Administration, China Medical University, 91 Hsueh Shih Road, Taichung 404, Taiwan.
    Affiliations
    Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan

    Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan

    Department of Health Services Administration, China Medical University, Taichung, Taiwan
    Search for articles by this author
Published:December 03, 2017DOI:https://doi.org/10.1016/j.ejim.2017.11.017

      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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