This study by Stack et al.14 evaluated national incidence data for 107 922 new patients from the Centre for Medicare and Medicaid Services Medical Evidence Form between 1 May 1995 and 31 July 1997 to see whether PD offered improved survival to HD for those patients with congestive heart failure (CHF). CHF was defined according to the medical evidence form and data were merged with the USRDS mortality and transplant data. Data were also adjusted for many comorbidities, including age, gender, cancer, peripheral vascular disease,
body mass index and glomerular filtration rate, and were censored when patients switched modalities. Median patient follow up was for 12 months. The adjusted analysis of the total patient cohort demonstrated a lower risk of death for PD compared with HD for up to 12 months of follow up, equal survival for 12–18 months HKI-272 datasheet and higher risk of death after 18 months. When subgroup analysis was carried
out, a significantly poorer survival for both non-diabetic and diabetic patients with CHF was found after 6 months if they commenced on PD therapy compared with HD. Non-diabetic patients without CHF had a 10% lower mortality risk if they commenced with PD than those commencing on HD. Limitations: The same limitations apply to this study as all observational cohort studies based on ITF2357 clinical trial registry data – possible selection bias, survival bias due to using prevalent cohorts and statistical bias that may ignore time-dependent effects of treatment modality on mortality. The cohort of patients was only studied for 2 years. There is also the possibility of
errors in Aspartate reporting of comorbidities when relying on the medical evidence form for patient characteristics. Data were not adjusted for nutritional indices or dialysis adequacy. A national cohort of 107 922 incident patients were studied by Ganesh et al.15 from the US Medicare and Medicaid Services and linked to mortality data from the USRDS over 2 years. Patients were stratified according to the presence or absence of coronary artery disease (CAD) and presence or absence of diabetes. The results demonstrated that the RR of death comparing HD and PD varied significantly over time. The adjusted data analysis demonstrated a survival advantage for patients commencing with PD; however, this advantage was only noted in the first 6 months of dialysis. Subgroup analysis demonstrated that: those patients with diabetes and CAD treated with PD had a 23% higher RR of death compared with similar HD patients To summarize, regardless of diabetic status, patients with CAD on PD had significantly poorer survival than those on HD. Limitations: Due to the study’s observational nature, there may have been selection bias towards one modality over the other. By using the Centre for Medicaid and Medicare Services data for the analysis, there may have been under-reporting of the population’s comorbidities. No data was available on dialysis adequacy or patient nutritional status.
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