Adults

Study IDGuo 2003Heaf 2002Huisman 2002Jaar 2009Mujais 2006 (case-control)
Dialysis sequencePD
HD-PD
transplant-PD
PD-HD
HD-PD
HD
PD-HD
PD
PD-HD
PD
HD-PD
transplant-PD
Mortality (where reported, also deaths in first 3 months)Rates of survival
Patients on peritoneal dialysis transferred from haemodialysis appeared to have lower rates of survival than patients new to dialysis (p<0.0001 for 1999, 2000; p<0.05 for 2001)

Patients on peritoneal dialysis transferred from haemodialysis appeared to have lower rates of survival than patients with a failed transplant (no p value or statistical analysis reported)

1yr survival new to peritoneal dialysis 83.12%; 2yr 69.94%; 3yr 58.12%
1yr survival post transfer from haemodialysis 79.87%; 2yr 66.07%; 3yr 56.00%
1yr survival after failed transplant 91.42%; 2yr 82.71%; 3yr 74.65% (1999 data only)
Mortality
RR 1.11 (95% CI 1.06 to 1.18) per change of modality independent of age and mortality

Haemodialysis patients had increased mortality in the ‘second career’ compared with the ‘first’; with accelerated mortality during first 6 months (37.2% per year; sem 4.6)

Patients who changed tended to be sicker (9% haemodialysis and 3% peritoneal dialysis with increased prevalence of atherosclerosis)
Survival
No difference in survival between patients in whom peritoneal dialysis failed (transferred to haemodialysis) and in whom haemodialysis was started and maintained (p=0.26)
Mortality rate
18.5 per 100 pt-yrs peritoneal dialysis non- switchers
13.5 for peritoneal dialysis switchers to haemodialysis

RR 0.94 death (95% CI 0.51 to 1.73) switchers vs non- switchers
No change in effect when adjusted for baseline variables
Rates of survival
Survival was similar across all groups (no p value or statistical analysis reported)
1yr survival new to peritoneal dialysis 91.10%; 2yr 87.64%; 3yr 81.96%; 4yr 74.37%
1yr survival post transfer from haemodialysis 89.86%; 2yr 83.34%; 3yr 76.88%; 4yr 73.03%
1yr survival after failed transplant 90.71%; 2yr 85.08%; 3yr 78.83%; 4yr 75.80%

From: Appendix A, Evidence review

Cover of Peritoneal Dialysis
Peritoneal Dialysis: Peritoneal Dialysis in the Treatment of Stage 5 Chronic Kidney Disease.
NICE Clinical Guidelines, No. 125.
Centre for Clinical Practice at NICE (UK).
Copyright © 2011, National Institute for Health and Clinical Excellence.

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