Survival Differences by Dialysis Modality among Incident End-stage Renal Disease Patients with Preexisting Coronary Artery Disease
관상동맥질환이 합병된 말기신부전 신환에서 투석방법의 차이가 환자생존에 미치는 영향
Song, YS; Jung, H; Park, JE; Kim, MJ; Im, BK; Chung, HJ; Oh, C; Shin, GT; Kim, H
Taehan Sinjang Hakhoe chi, 24(5):778-788, 2005
Taehan Sinjang Hakhoe chi; The Korean journal of nephrology; 대한신장학회지
Background: The question of which dialysis modality should be recommended to end-stage renal disease (ESRD) patients with a history of coronary artery disease (CAD) is encountered frequently in clinical practice, and the answer is still controversial. We tried to explore the patient’s survival difference by the dialysis modality in incident ESRD patients with CAD.
Methods: We retrospectively analyzed survival differences by dialysis modality in 56 new ESRD patients with preexisting CAD (HD:PD=30:26) at yearly intervals with Poisson regression from September 1994 to February 2000. We also investigated the predictors of mortality with multivariate analysis by time-dependent Cox regression.
Results: There were no significant differences in age, sex, diabetes, co-morbidity, severity of CAD on commencement of dialysis between HD and PD patients with CAD. Cardiovascular deaths were observed in only HD group. In the CAD group, the relative risk (RR) of mortality in HD patients was equal or higher than that in PD patients for the first 3 years, but RR became lower in HD patient after 3 years. The significant predictors of mortality in CAD group were age, diabetes, arrhythmia and history of cardiac arrest at the time of dialysis initiation.
Conclusion: When we choose a dialysis modality in incident ESRD patient with preexisting CAD, we could consider an early survival benefit of PD over HD and integrated dialysis approach as a treatment option in this patient group. Further investigation including control group is needed to evaluate in the multicenter, large-scaled manner.
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