First Initiative Peritoneal Dialysis versus Hemodialysis for the Treatment of Renal Failure: A Review of Clinical Effectiveness and Guidelines


( Last Updated : February 8, 2016)
Project Line:
Health Technology Review
Project Sub Line:
Summary with Critical Appraisal
Project Number:
RC0745-000

Details


Question


  1. What is the comparative clinical effectiveness of peritoneal dialysis versus hemodialysis for the first initiative treatment of renal failure in adult patients?

  2. What are the evidence-based guidelines regarding optimal first line dialysis for the treatment of renal failure in adult patients?

  3. What are the evidence-based guidelines regarding optimal peritoneal dialysis care for the treatment of renal failure in adult patients?


Key Message

​There was evidence that the overall survival outcomes associated with PD as initial dialysis modality was, at least, comparable to outcomes associated with HD as initial dialysis modality, with a trend suggesting higher survival rates among patients initiated on PD. Furthermore, there was evidence suggesting that younger patients (< 65 years) may benefit more from PD compared with older patients (˃ 65 years old). Although PD was associated with significantly lower risk of bacteremia than HD, the rate of mortality due to infections was not statistically significantly different between the two groups. There was no interaction between the initial dialysis modality and gender or diabetes mellitus with regards to mortality. Patients for whom PD was the initial dialysis modality were not associated with impaired prognosis compared with those who had HD as initial dialysis modality. However, patients for whom PD was the initial dialysis modality were more likely to switch modality or to receive kidney transplantations. The literature search for this review did not find any guidelines regarding optimal first line dialysis modality or the optimal peritoneal dialysis care for the treatment of renal failure in adult patients.