A comparison of survival rates between end stage renal disease patients receiving hemodialysis and continuous ambulatory peritoneal dialysis at Phayao hospital

Abstract

This retrospective cohort study aims to compare survival rates and investigate the association between renal replacement therapy and all-cause mortality. Data were retrospectively collected from the medical records of patients who underwent their initial renal replacement therapy at Phayao Hospital between January 1, 2018, and December 31, 2019, and maintained consistent renal replacement therapy modalities throughout the follow-up period. Subsequently, all-cause mortality was monitored until December 31, 2022. Survival rates between hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) groups were analyzed using Kaplan-Meier curves, and the comparison was made with log-rank statistics. The association between patterns of renal replacement therapy and the risk of all-cause mortality was tested using Cox regression, adjusting for confounding factors such as gender, age, treatment rights, comorbidities (hypertension, diabetes, cardiovascular disease), renal function (eGFR), hematocrit level, and stratified with hyperlipidemia. Results indicated that among 115 individuals initiating renal replacement therapy, 58 (50.4%) succumbed to any causes during a median follow-up of 35 months 21 days. The survival time for HD (59 months 21 days) was significantly higher than for the CAPD group (32 months 18 days) (P = .007). CAPD was also associated with an increased risk of all-cause mortality compared to HD, with an adjusted hazard ratio (adjusted HR) of 2.5 (95% CI: 1.28 to 5.05, P = .008). We observed diabetes mellitus as an effect modifier; peritoneal dialysis in diabetic patients was linked to a significantly higher risk of death (adjusted hazard ratio 7.96 [95% CI: 1.67 to 37.84], P-value for interaction = .041). Although this research cannot establish a causal relationship, it suggests the importance of monitoring patients undergoing CAPD. These findings also prompt future studies aimed at improving the survival rate for these patients.