Viewpoint On
Banshodani M, Kawanishi H, Moriishi M, Shintaku S, Tsuchiya S: Association between Dialysis Modality and Cardiovascular Diseases: A Comparison between Peritoneal Dialysis and Hemodialysis. Blood Purif DOI 10.1159/000504040
The mortality and occurrence of cardiovascular (CV) events appears to be similar between patients receiving peritoneal (PD) or hemodialysis (HD) for end-stage kidney disease (ESKD), if the pre-dialysis-co-morbidity and age are similar. But this remains controversial and widely debated, due to inconsistency of findings and the lack of a well-designed large randomized controlled trial (RCT) with prolonged follow up.
Banshodani and co-workers add to the database a small, single-center, observational study employing propensity matching to simulate a RCT.
130 PD prevalent patients were matched to 130 prevalent HD patients according to multiple demographic and clinical parameters and followed for similar periods of time.
The rate of emergency hospitalization for CV causes (mainly congestive heart failure) and all-cause mortality (mainly due to CV disease) was higher in PD patients.
The study had many weaknesses. It was not designed to uncover the mechanisms responsible for the observed differences. Minor differences in clinical characteristics between the PD and HD cohorts (such as serum albumin levels, serum potassium of corrected calcium) might have contributed to the differences seen. Higher atherogenic glucose loads or glucose degradation products (GDP) in PD fluids might be explanatory, although low GDP containing PD fluids were utilized. No bio-impedance studies were performed to objectively quantify differences in volume expansion occurring between the two groups.
This study is primarily hypothesis generating at best due to its small size and single center nature. It is subject to a high risk of bias due to confounding effect of measured and unmeasured variables. It is difficult to generalize these findings to the universe of PD and HD patients.
