File Name: difference between hemodialysis and peritoneal dialysis .zip
The dataset used in the analysis is available with the corresponding author and will be released on request. Nutritional factors are associated with high mortality and morbidity in dialysis patients, and protein-energy wasting is regarded as an important one. The results of prevalent HD and PD patients were then compared.
For renal replacement therapy, overall survival is more important than the choice of currently available individual therapy. To compare patients and technique survival on peritoneal dialysis as first treatment PDF versus after previous haemodialysis HDPD and other indicators of follow-up. We prospectively studied incident patients, during the period from August 4, , to June 30, , for patients and technique survival Kaplan-Meier log rank. Groups: A PDF: 37 patients, 24 females, age: Comparable patient and technique survival were observed.
Descargar PDF. Texto completo. Suplemento 3. Blake Director Peritoneal Dialysis. Associate Professor Medicine.
Optimal Dialysis Research Unit. London Health Sciences Centre. University of Western Ontario. Such comparisons can be done on the basis of quality of life, hospitalization, technique survival and cost effectiveness. Initial studies addressing this issue from a variety of centres in North America and Western Europe were published between and and, in general, showed no consistent survival advantage for either modality However, in , Bloembergen y cols.
This publication gave rise to concern about the viability of PD as a long term renal replacement therapy and may have contributed to the recent decrease in the percentage of patients managed with PD in North America 8. In , however, Fenton y cols. These apparently contrasting results have given rise to confusion. More recent studies, however, are helping to clarify this complex area.
These include, in particular, some of the following: Correspondencia: Dr. Peter G. A large number of patients are required to show a significant survival difference between the two modalities and so such studies are typically based on national or regional registry data. However, even the best registries have limitations in terms of the completeness of data collection and the availability of information on baseline patient characteristics, such as comorbidity.
Such studies are, by their nature, retrospective and should not be interpreted as if they are prospective randomized control trials. Most of the studies are based on incident patients, but some, including that by Bloembergen y cols.
In general, incident-based studies are preferable as they avoid the bias that may result from an excess of early events on one or other modality. Neither method is inherently superior as each attempts to answer a different question. ITT studies are most useful clinically in that they determine whether the initial modality selection influences ultimate survival.
TR studies, however, may be more likely to detect any real difference that may exist between the two modalities. Almost all studies adjust for age, sex, and diabetic status. Ideally, they should also correct for the number and severity of baseline comorbid conditions as well as functional status.
This is not always the case in practice because, as already noted, registry-based studies rarely have more than limited comorbidity data. This is particularly important because it is a common observation that patients who present late, or in a critically ill state with end stage renal disease, tend to be initially treated with HD.
This may introduce a bias in favour of PD if correction for this baseline comorbidity is not adequate. The statistical technique used to compare survival on the two modalities is typically the Cox Proportional Hazards model which presumes that the relative risks or hazards between the two modalities stay constant with the time. This is clearly not the case in practice. A number of studies have noted that the death rate in the first years is relatively higher on HD than PD, but that the opposite tends to be the case in subsequent years 9, This disproportionality is the fundamental cause underlying much of the confusion in the literature and explains why PD looks better in studies based on incident as compared to prevalent patients.
Modality switches from PD to HD are much commoner than those in the opposite direction. In a pure ITT analysis, this is not an issue, but, in TR analyses or in ITT analyses that are modified by censoring at the time of a modality switch, it is a potential problem and there is a concern that mortality occurring on the second modality may unfairly be attributed to the first modality.
During this time, any deaths are attributed to the previous modality. In practice, this tends to have less effect on the outcome of studies than might be expected. Practices are continually changing in both PD and HD; ideally, comparative studies should deal with a contemporary period, or else the results will be very out of date and may not be applicable to present day patients.
As already stated, correction for baseline comorbidity is important. Correction for ongoing comorbidity or for laboratory variables measured subsequent to initiation of dialysis is not appropriate, however, as these may be a consequence of the therapies being compared.
For example, ongoing adjustment for residual renal function might correct away one of the advantages of PD while ongoing adjustment for serum albumin would be similarly unfair to HD. The Bloembergen study has some weaknesses.
It was a point prevalent one and so omitted a lot of early time on dialysis 7. Because of the disproportionate hazards issue mentioned above, this makes HD look better relative to PD. It also did not correct for comorbidity and dealt with a period that is more than a decade ago.
The Fenton study was methodologically superior in that it was based on incident patients and used both ITT and TR analyses which gave similar results 9, It included correction for comorbid conditions, but this was inevitably limited and there is concern that PD patients in Canada may be significantly more healthy at baseline.
Newer studies have clarified these issues somewhat. Vonesh y cols. The advantage of HD over PD has decreased in successive cohorts to the point of being statistically and clinically insignificant, although an excess mortality persists in older diabetics and in black patients. These results may be explained by the fact that a period prevalent analysis includes a greater proportion of data from the early years on PD and so gives correspondingly better results for PD.
An additional explanation may be that there has been an actual improvement in relative outcomes on PD over the past decade. Collins y cols. This again, emphasizes how incident studies which are generally preferred, are associated with better results for PD, relative to HD.
Recently, Murphy y cols. They have shown that there is no difference in outcome between PD and HD patients in Canada when correction for baseline comorbidity and functional status is very detailed.
It thus appears that the methodology used has an enormous influence on the result of comparative mortality studies. It is desirable that incident patients be studied and when this is done, the advantage for HD seen in the US is no longer as marked as is the case in the Bloembergen study.
Indeed, it may not be present at all as suggested by the recent data from Collins y cols. Thus, the differences between the two modalities in the two countries are not as marked as initially appeared to be the case. Much less published information is, unfortunately, available from elsewhere.
Australian data on incident patients using ITT show an advantage for HD, but a more contemporary study in prevalent patients, showed no difference In the Lombardy Registry from Northern Italy, HD had a significant survival advantage, but there was a significant excess of baseline comorbidity in PD patients 8, The opposite trend was seen in studies by Maiorca y cols.
European Registry data addressing comparative mortality has not been published in recent years, but new information becoming available suggests that mortality on PD was historically higher, but that the gap has closed steadily over the past 20 years. PD, in general, appears to do well early on, but less so later, perhaps due to better retention of residual renal function in the early years and also perhaps due to less unmeasured baseline comorbidity.
HD, in many studies, seems to do better in later years and may be relatively superior in older diabetics, while PD may have the advantage in younger diabetics. Results to date, do not reflect recent radical changes in PD prescription practices and these may impact on results that become available in the future.
None of these data come from prospective randomized control studies and there is no justification for directing different sub groups to a particular modality. For now, modality selection should depend on individual patient issues and, most notably, patient preference. Patients who are doing poorly on a given modality, despite optimal practices, should be considered for early modality switch.
However, the two modalities should be considered as complementary rather 14 than competitive and many patients may well require both during their time of dialysis. Lancet 1: , Perit Dial Int , Am J Kidney Dis , Nephrol Dial Transplant 6: , J Am Soc Nephrol 3: , J Am Soc Nephrol 6: , J Am Soc Nephrol 7: , J Am Soc Nephrol , J Am Soc Nephrol 8: A, The Canadian Experience: Factor or Fiction? J Am Soc Nephrol 9: A, J Am Soc Nephrol , 9: A. D i s n e y A: Demography and survival of patients receiving t r e a t m e n t for chronic renal failure in Australia and New Z e a l a n d : Report on dialysis and renal transplantation treatment from the Australia and New Zealand Dialysis a n d Transplant Registry.
Am J Kidney Dis 2 5 : , J Am Soc Nephrol 7: A, Are you a health professional able to prescribe or dispense drugs?
A growing number of patients are returning to dialysis after renal transplant failure. The aim of this study is to determine whether peritoneal dialysis PD is a safe and good treatment option for these patients. There were no significant differences in age, sex, serum albumin- and CRP-levels at baseline. The total time on renal replacement therapy at transplant failure and time to transplant failure did not differ between the two groups either. Furthermore, the baseline comorbidity was similar in both groups. During follow-up, the outcome did not differ significantly between the two groups.
Descargar PDF. Texto completo. Suplemento 3. Blake Director Peritoneal Dialysis. Associate Professor Medicine. Optimal Dialysis Research Unit.
Patients on peritoneal dial- ysis proved to have more normal concentrations of BUN, hemo- globin, potassium, bicarbonate, and high-density lipoproteins.
During peritoneal dialysis, a cleansing fluid dialysate is circulated through a tube catheter inside part of your abdominal cavity peritoneal cavity. The dialysate absorbs waste products from blood vessels in your abdominal lining peritoneum and then is drawn back out of your body and discarded. Peritoneal dialysis per-ih-toe-NEE-ul die-AL-uh-sis is a way to remove waste products from your blood when your kidneys can't adequately do the job any longer. This procedure filters the blood in a different way than does the more common blood-filtering procedure called hemodialysis.
The Journal publishes articles on basic or clinical research relating to nephrology, arterial hypertension, dialysis and kidney transplants. It is governed by the peer review system and all original papers are subject to internal assessment and external reviews. The journal accepts submissions of articles in English and in Spanish languages. The Impact Factor measures the average number of citations received in a particular year by papers published in the journal during the two receding years. CiteScore measures average citations received per document published.
Before dialysis was available, total kidney failure meant death. Today, people with kidney failure can live because of treatments such as dialysis and kidney transplant. Dialysis is a way of cleaning your blood when your kidneys can no longer do the job. It gets rid of your body's wastes, extra salt and water, and helps to control your blood pressure. There are two kinds of dialysis. In hemodialysis, blood is pumped out of your body to an artificial kidney machine, and returned to your body by tubes that connect you to the machine. In peritoneal dialysis, the inside lining of your own belly acts as a natural filter.
Kidney failure can be treated by either hemodialysis or peritoneal dialysis. Both processes involve the removal of waste and extra fluid from the body.
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Both processes involve the removal of waste and extra fluid from the body. Hemodialysis is done with the help of an apparatus called a dialyzer.Reply