Impact of dialysis modality on major adverse cardiovascular events and all-cause mortality: a national population-based study

Background. Only few studies with inconsistent results comparing the relative risk of cardiac mortality between peritoneal dialysis (PD) and hemodialysis (HD). Switches between renal replacement therapy (RRT) modalities render objective assessment of survival benefits a greater challenge. Methods. Data were retrieved from Taiwan's National Health Insurance Database from 1 January 2006 to 31 December 2015. We included 13662 and 41047 long-term dialysis patients in a propensity score matching study design and a time-varying study design, respectively, to compare major adverse cardiovascular events (MACEs) between patients receiving PD and HD. We also included 109256 dialysis patients to compare the all-cause mortality among different RRT modalities. Results. For MACE, the hazard ratio (HR) for PD patients compared to HD patients was 0.95 [95% confidence interval (CI) 0.89-1.02] in the propensity score study design and 1.06 (95% CI 1.01-1.12) in the time-varying study design. For all-cause mortality, the HR for PD patients compared to HD patients was 1.09 (95% CI 1.05-1.13) in the propensity score study design and 1.13 (95% CI 1.09-1.17) in the time-varying study design. The HR for death was higher at a level of statistical significance for females (1.21, 95% CI 1.15-1.28), patients >= 65 years old (1.30, 95% CI 1.24-1.36) and diabetes mellitus (DM; 1.28, 95% CI 1.22-1.34). Conclusions. The HR for MACE is significantly higher among PD patients in time-varying design analysis. In addition, all-cause mortality was higher in PD patients compared to patients with HD, especially in those who were aged >= 65 years, female or DM.

Automated summary

The study found that the risk of major adverse cardiovascular events (MACE) was similar between peritoneal dialysis (PD) and hemodialysis (HD) patients in both propensity score matching and time-varying design analyses. However, the all-cause mortality rate was higher in PD patients, especially among those aged >= 65 years, female, or with diabetes mellitus (DM).