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The type of dialysis used by patients with end-stage renal disease may affect their survival

Most patients with end-stage renal disease (ESRD) must use dialysis for renal replacement therapy. The type of dialysis selected by patients with ESRD may affect their survival, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS08365). Researchers found that the risk for death during the first year of treatment did not differ between patients undergoing peritoneal dialysis (PD), which can be done by the patient at home, and those undergoing hemodialysis (HD), which must be done at a dialysis center. However, after the second year, the risk of death was significantly higher in PD than in HD patients.

The researchers compared the risk of death among 1,041 patients receiving dialysis and followed the patients for up to 7 years. Patients initiating treatment with PD appeared healthier and of higher socioeconomic status than did those receiving HD. After adjustment for several factors, the risk of death did not differ between patients undergoing PD or HD during the first year but the risk more than doubled among PD patients in the second year.

The researchers suggest several possible reasons for the increased risk of death in the second year. First, residual renal function in the kidneys facilitates the regulation of fluid and electrolyte balance, and has been linked with improved nutritional status and survival. Loss of residual renal function and urine output over time in patients undergoing PD has been associated with an increased mortality rate, possibly due to inadequate dialysis or volume overload. Secondly, PD patients are usually seen less often by nephrologists, who can identify and manage problems as they arise.

See "Comparing the risk for death with peritoneal dialysis and hemodialysis in a national cohort of patients with chronic kidney disease," by Bernard G. Jaar, M.D., M.P.H., Joseph Coresh, M.D., Ph.D., Laura C. Plantinga, Sc.M., and others, in the August 2005 Annals of Internal Medicine 143, pp. 174-183.

Editor's note: Another article on dialysis concludes that a genetic variation in the beta-fibrinogen gene likely does not play an important role in determining the variation in elevated plasma fibrinogen levels or excess cardiovascular disease risk in dialysis patients. More details are in: Liu, Y., Berthier-Schaad, Y., Fink, N.E., and others (2005, July). "Fibrinogen haplotypes and the risk for cardiovascular disease in a dialysis cohort." (AHRQ grant HS08365). American Journal of Kidney Diseases 46(1), pp. 78-85.

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