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Hemodialysis better for end-stage renal disease patients with CHF: compared with peritoneal dialysis.

MIAMI BEACH -- Hemodialysis may be preferable to peritoneal dialysis in patients with both end-stage renal disease and congestive heart failure, based on data on more than 100,000 patients.

"The popular belief is that peritoneal dialysis is superior for end-stage renal disease (ESRD). This analysis suggests the contrary," Dr. Austin Stack said at a conference on cardiovascular disease epidemiology and prevention sponsored by the American Heart Association.

The prevalence of congestive heart failure (CHF) is high among people with ESRD; patients with such comorbidity have increased mortality. Some experts suggest that peritoneal dialysis would be superior to hemodialysis because of improved volume regulation and less hemodynamic stress, noted Dr. Stack of the University of Texas, Houston.

He analyzed data on 107,922 patients newly placed on dialysis between 1995 and 1997, linking records from the Centers for Medicare and Medicaid Services with mortality data from the U.S. Renal Data System. There were 27,149 deaths, 5,423 transplants, and 3,753 patients lost to follow-up. He used Cox regression analysis to determine the hazard ratio for mortality during 2 years of follow-up, adjusting for demographic factors and 13 comorbid conditions.

Patients with CHF starting peritoneal dialysis were healthier and tended to be younger and have increased serum albumin, which "would favor survival in peritoneal dialysis patients," said Dr. Stack. He added that poorer survival was seen at 2-year follow-up.

The prevalence of CHF was 33% at onset of ESRD. Diabetics with CHF treated with peritoneal dialysis had a 30% higher mortality risk than those on hemodialysis. Nondiabetics with CHF treated with peritoneal dialysis had a 24% higher risk of mortality than those on hemodialysis.


Miami Bureau
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Title Annotation:congestive heart failure
Author:McNamara, Damian
Publication:Internal Medicine News
Date:Sep 1, 2003
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