2022 Jan 7. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan–.
ABSTRACT
Peritoneal dialysis (PD) accounts for a small percentage (less than 7%) of the prevalent dialysis population in the United States compared to Canada (more than 50%). Better early survival on PD compared to hemodialysis (HD) has also been reported by several observational studies, including national registries from different parts of the world. The cost of HD per patient per year remains significantly higher than for PD ($87,945 for HD versus $71,630 for PD in 2011). Patients have a choice when initiating dialysis to use HD or PD. Choice should be patient-centered and made after careful considerations of all factors that may alter outcomes. A large US cohort study of over 6000 matched pairs of dialysis patients beginning dialysis in 2003, showed that 1-year patient survival was significantly higher for PD when compared to HD (85.8% versus 80.7% (p < 0.01)). However, 80% of end-stage renal disease (ESRD) patients in the United States start hemodialysis (HD) with a tunneled hemodialysis catheter (TDC), and 60% continue to dialyze using an HDC for 91 days after dialysis initiation. This initial catheter (modality) choice has had a major impact on the mortality of ESRD patients. Patient mortality in the first 90 days of HD as a result of catheter-associated bacteremia and sepsis from TDC use is higher when compared to patients initiating dialysis on PD. A significant percentage of deaths in HD occurred within the first the 90 days on dialysis.