Перевод с перитонеального на гемодиализ у пациентов старше 80 лет повышает риск смерти

TOPLINE Initial dialysis modality does not affect long-term survival in adults aged 80 years or older, but switching from peritoneal dialysis (PD) to hemodialysis (HD) was associated with increased mortality in a cohort study of octogenarians. METHODOLOGY Advanced age is commonly accompanied by frailty, multimorbidity, cognitive impairment, and limited life expectancy, posing distinct clinical and ethical challenges in dialysis decision-making. Despite this, the optimal dialysis modality for these patients remains unclear. Researchers conducted a real-world retrospective cohort study using data from an official population-based registry (2000-2022) to compare long-term survival in octogenarians by initial dialysis modality and to assess the effect of switching from PD to HD. The primary outcome was overall survival, defined as the time from dialysis initiation to death or end of follow-up, with kidney transplantation treated as a censoring event. TAKEAWAY Investigators analyzed data from patients who initiated HD (n = 3966; mean age, 83.2 years; 38.7% women) or PD (n = 239; mean age, 83.1 years; 32.6% women). After propensity score matching, the analysis included 637 patients receiving HD and 213 receiving PD. During a median follow-up of 3 years in both groups, 63 patients who initiated PD switched to HD; the main reasons included loss of peritoneal membrane function, severe intercurrent illness, PD-related infections, and patient choice. After adjustment for baseline characteristics and modality transitions, 5-year survival did not differ significantly by initial dialysis modality (HD vs PD). Switching from PD to HD was independently associated with a 46% increased risk for mortality (adjusted hazard ratio [aHR], 1.46; P =.038). Older age at dialysis initiation (aHR, 1.06 per year; P  <.001) and initiation of kidney replacement therapy in 2000-2007 (aHR, 1.37; P =.007) were also independently associated with increased mortality risk. IN PRACTICE “Transition from PD to HD was associated with increased mortality, likely reflecting underlying clinical deterioration rather than a direct effect of the modality change,” the authors of the study wrote. SOURCE The study was led by Néstor Toapanta, Vall d’Hebron University Hospital, Vall d’Hebron Research Institute, Autonomous University of Barcelona, Barcelona, Spain. It was published online in Clinical Kidney Journal. LIMITATIONS The study could not exclude residual confounding from unmeasured variables such as frailty, cognitive function, nutritional status, and adequacy of home support. The relatively small number of patients who switched from PD to HD limited the precision of risk estimates for this subgroup. The lack of center-level data also prevented adjustment for differences in PD program organization across dialysis units. DISCLOSURES No funding information was provided for this study. The authors declared no conflicts of interest. This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.