Dialysis Modality Outcomes in End-Stage Renal Disease
Summary
End-stage renal disease (ESRD) represents the terminal phase of chronic kidney impairment, necessitating renal replacement therapy. The two principal modalities, haemodialysis and peritoneal dialysis, differ in mechanism, setting and potential complications. Haemodialysis employs an extracorporeal circuit and dialyser to clear solutes and fluid, whereas peritoneal dialysis utilises the patient’s peritoneal membrane for exchange. Outcomes encompass survival, cardiovascular events, infection risk, quality of life and preservation of residual renal function. Modality choice is influenced by patient age, comorbidity profile, lifestyle considerations and resource availability. Emerging evidence supports home-based treatments and hybrid regimens combining once-weekly haemodialysis with peritoneal dialysis. Shared decision-making, informed by prognostic models and health-economic analyses, underpins personalised dialysis prescriptions. Global trends reveal narrowing survival differences and variable cardiovascular morbidity between modalities, underscoring the need for ongoing comparative effectiveness research and quality-improvement initiatives.
Research from Nature Portfolio
Recent prospective cohort work in South Korea examined over 2,200 incident ESRD patients, revealing no overall difference in mortality hazard between initial haemodialysis and peritoneal dialysis. Landmark analyses identified a higher long-term hazard for peritoneal dialysis in patients under 65 and in those with diabetes, informing age- and comorbidity-specific modality selection. A nationwide Japanese registry study of nearly 9,000 prevalent peritoneal dialysis patients identified older age, diabetes, cardiovascular comorbidity and markers of inflammation as independent predictors of mortality; combined therapy with once-weekly haemodialysis was associated with lower death rates. A population-based analysis of almost 97,000 Korean dialysis initiators demonstrated a secular improvement in peritoneal dialysis outcomes, with early excess mortality over haemodialysis abating by 2012–2015 and mirroring trends in nonfatal cardiovascular events. These studies highlight evolving modality-specific survival profiles and the potential of combination strategies to improve prognosis.
Dialysis Modality Outcomes in End-Stage Renal Disease publication trend
The graph below shows the total number of articles in dialysis modality outcomes in end-stage renal disease across all publications each year (not limited to Nature Index journals).
Technical terms
End-stage renal disease (ESRD): Advanced kidney failure requiring lifelong renal replacement therapy.
Haemodialysis (HD): A procedure using an external membrane to filter blood and remove toxins and excess fluid.
Peritoneal dialysis (PD): A technique using the peritoneal lining as a semi-permeable membrane for solute and fluid exchange.
Hazard ratio (HR): A measure comparing the rate of an event occurring in one group versus another over time.
Propensity score matching: A statistical method to balance baseline characteristics between treatment groups in observational studies.
References
- The effect of dialysis modality on annual mortality: A prospective cohort study. Scientific Reports (2024).
- Predictors of outcomes in patients on peritoneal dialysis: A 2-year nationwide cohort study. Scientific Reports (2019).
- Combination of once-weekly haemodialysis with peritoneal dialysis is associated with lower mortality compared with peritoneal dialysis alone: a longitudinal study. Clinical Kidney Journal (2020).
- Comparative study of peritoneal dialysis versus hemodialysis on the clinical outcomes in Korea: a population-based approach. Scientific Reports (2019).
- The impact of the Starting dialysis on Time, At home on the Right Therapy (START) project on the use of peritoneal dialysis. Advances in Peritoneal Dialysis (2024).
- Home Versus Facility Dialysis and Mortality in Australia and New Zealand. American Journal of Kidney Diseases (2021).
- A comparison of the risk of congestive heart failure-related hospitalizations in patients receiving hemodialysis and peritoneal dialysis - A retrospective propensity score-matched study. PLOS ONE (2019).
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