Peritoneal dialysis offers same outcomes as hemodialysis, but is rarely used

Although hemodialysis and peritoneal dialysis result in similar outcomes for most patients, few patients are choosing peritoneal dialysis, according to two new studies published by Archives of Internal Medicine.

The first study used data from the U.S. Renal Data System (USRDS) to uncover and compare trends in survival among patients on the two modes of dialysis. More than 600,000 hemodialysis patients and almost 65,000 peritoneal dialysis patients were included, and they were followed for up to five years. Three date ranges were included: 1996-1998, 1999-2001 and 2002-2004.

Although in the earlier date ranges there was a higher risk of death for patients on peritoneal dialysis, that risk progressively attenuated so that there was no significant difference by 2002-2004. Analyses of 8 subgroups (patients of different ages and comorbidities) showed that only older patients with diabetes and at least one other comorbidity were more likely to die on peritoneal dialysis in the most recent time range. But even that risk had become progressively lower over time.

The findings, and the lower cost, support broader use of peritoneal dialysis, especially in younger and nondiabetic patients, the authors concluded. They did caution, however, that the improvements in outcomes could be the result of more selective assignment of patients to peritoneal dialysis in recent years.

Peritoneal dialysis patients are a relatively small group, confirmed the second study. The cohort study surveyed patients in the USRDS from 2005 to 2007 about whether peritoneal dialysis had been discussed with them. Sixty-one percent of the patients said they had discussed it, which was a higher proportion than previous studies have found. However, only 10.9% of those patients initiated peritoneal dialysis. The rates of peritoneal dialysis differed by region of the country and the dialysis organization caring for the patient.

The results indicate that nephrologists are discussing peritoneal dialysis with patients, but the quality and quantity of the information presented may be lacking, according to an editorial accompanying the studies. A problematic cycle may be under way in which fewer patients undergo peritoneal dialysis and so fewer physicians receive extensive training on their care, the editorialist speculated. That dynamic may be changed by the recently added Medicare benefit covering education for patients with stage 4 chronic kidney disease. If these initiatives successfully reverse the trend of decreasing peritoneal dialysis use, patient satisfaction may be increased while not compromising cost-effectiveness or survival, the editorialist concluded.