Document Detail


Is the declining use of long-term peritoneal dialysis justified by outcome data?
MedLine Citation:
PMID:  17942769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In the past decade, peritoneal dialysis use among patients with end-stage renal disease has declined in many countries. Studies from the United States indicate that many academic centers do not have adequate resources to train fellows, most incident dialysis patients are not offered peritoneal dialysis, and more than half of dialysis clinics do not have the infrastructure to support peritoneal dialysis. Some are concerned that the outcomes of peritoneal dialysis and maintenance hemodialysis patients may not be equivalent, a notion that is not supported by outcome studies. Given the effect of modality selection on patients' lifestyle, attempts to conduct a randomized, controlled comparison of maintenance hemodialysis and peritoneal dialysis have been unsuccessful. Most observational studies showed that peritoneal dialysis is associated with a survival advantage that diminishes over time; it is unclear whether any of the differences over time are attributable to the modality. Between 1996 and 2003, the early outcomes of peritoneal dialysis patients further improved, whereas those for maintenance hemodialysis patients remained unchanged. Differences in outcomes may be due to residual statistical confounding; however, several biologic mechanisms can be postulated: The early survival advantage may be related to the better preservation of residual renal function with peritoneal dialysis, and the diminution of the survival advantage may be related to worsened volume control. There is a need for large observational and interventional studies among peritoneal dialysis patients to sustain and enforce the improvements in both dialysis therapies.
Authors:
Osman Khawar; Kamyar Kalantar-Zadeh; Wai Kei Lo; David Johnson; Rajnish Mehrotra
Related Documents :
19379399 - Effect of long-term increase in the frequency and/or prolongation of dialysis duration ...
12425489 - Characterization of treatment dose delivered by albumin dialysis in the treatment of ac...
16207659 - Levocarnitine and dialysis: a review.
7435519 - Acute drug-associated rhabdomyolysis: an examination of its diverse renal manifestation...
20404719 - A novel bioimpedance technique to monitor fluid volume state during hemodialysis treatm...
8573899 - The effect of dialyzer membrane and etiology of kidney disease on the preservation of r...
20213489 - Enhancing the deceleration capacity index of heart rate by modified-phase-rectified sig...
12243549 - Ambulatory electrocardiographic evaluation of the heart in patients treated by megachem...
14967549 - Minor physical anomalies in patients with schizophrenia and their parents: prevalence a...
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review     Date:  2007-10-17
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  2     ISSN:  1555-905X     ISO Abbreviation:  -     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-26     Completed Date:  2007-11-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1317-28     Citation Subset:  IM    
Affiliation:
Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, USA.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Health Care Costs
Humans
Kidney Failure, Chronic / mortality,  therapy
Peritoneal Dialysis / economics,  mortality,  trends*
Renal Dialysis / economics,  mortality,  trends
Risk Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
RR18298/RR/NCRR NIH HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Genetic factors in diabetic nephropathy.
Next Document:  Cocaine use and hypertensive renal changes in HIV-infected individuals.