Abstract
Background/Aims: Since comorbidities are major determinants of modality choice, and also interact with dialysis modality on mortality outcomes, we examined the pattern of modality choice according to comorbidities and then evaluated how such choices affected mortality in incident dialysis patients. Methods: We analyzed 32,280 incident dialysis patients in Korea. Patterns in initial dialysis choice were assessed by multivariate logistic regression analyses. Multivariate Poisson regression analyses were performed to evaluate the effects of interactions between comorbidities and dialysis modality on mortality and to quantify these interactions using the synergy factor. Results: Prior histories of myocardial infarction (p = 0.031), diabetes (p = 0.001), and congestive heart failure (p = 0.003) were independent factors favoring the initiation with peritoneal dialysis (PD), but were associated with increased mortality with PD. In contrast, a history of cerebrovascular disease and 1-year increase in age favored initiation with hemodialysis (HD) and were related to a survival benefit with HD (p < 0.001, both). While favoring initiation with HD, having Medical Aid (p = 0.001) and male gender (p = 0.047) were related to increased mortality with HD. Furthermore, although the severity of comorbidities did not inf luence dialysis modality choice, mortality in incident PD patients was significantly higher compared to that in HD patients as the severity of comorbidities increased (p for trend < 0.001). Conclusions: Some comorbidities exerted independent effects on initial choice of dialysis modality, but this choice did not always lead to the best results. Further analyses of the pattern of choosing dialysis modality according to baseline comorbid conditions and related consequent mortality outcomes are needed.
| Original language | English |
|---|---|
| Pages (from-to) | 699-710 |
| Number of pages | 12 |
| Journal | Korean Journal of Internal Medicine |
| Volume | 32 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 2017 Jul |
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All Science Journal Classification (ASJC) codes
- Internal Medicine
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The pattern of choosing dialysis modality and related mortality outcomes in Korea : A national population-based study. / Kim, Hyung Jong; Park, Jung Tak; Han, Seung Hyeok; Yoo, Tae Hyun; Park, Hyeong Cheon; Kang, Shin Wook; Kim, Kyoung Hoon; Ryu, Dong Ryeol; Kim, Hyunwook.
In: Korean Journal of Internal Medicine, Vol. 32, No. 4, 07.2017, p. 699-710.Research output: Contribution to journal › Article
TY - JOUR
T1 - The pattern of choosing dialysis modality and related mortality outcomes in Korea
T2 - A national population-based study
AU - Kim, Hyung Jong
AU - Park, Jung Tak
AU - Han, Seung Hyeok
AU - Yoo, Tae Hyun
AU - Park, Hyeong Cheon
AU - Kang, Shin Wook
AU - Kim, Kyoung Hoon
AU - Ryu, Dong Ryeol
AU - Kim, Hyunwook
PY - 2017/7
Y1 - 2017/7
N2 - Background/Aims: Since comorbidities are major determinants of modality choice, and also interact with dialysis modality on mortality outcomes, we examined the pattern of modality choice according to comorbidities and then evaluated how such choices affected mortality in incident dialysis patients. Methods: We analyzed 32,280 incident dialysis patients in Korea. Patterns in initial dialysis choice were assessed by multivariate logistic regression analyses. Multivariate Poisson regression analyses were performed to evaluate the effects of interactions between comorbidities and dialysis modality on mortality and to quantify these interactions using the synergy factor. Results: Prior histories of myocardial infarction (p = 0.031), diabetes (p = 0.001), and congestive heart failure (p = 0.003) were independent factors favoring the initiation with peritoneal dialysis (PD), but were associated with increased mortality with PD. In contrast, a history of cerebrovascular disease and 1-year increase in age favored initiation with hemodialysis (HD) and were related to a survival benefit with HD (p < 0.001, both). While favoring initiation with HD, having Medical Aid (p = 0.001) and male gender (p = 0.047) were related to increased mortality with HD. Furthermore, although the severity of comorbidities did not inf luence dialysis modality choice, mortality in incident PD patients was significantly higher compared to that in HD patients as the severity of comorbidities increased (p for trend < 0.001). Conclusions: Some comorbidities exerted independent effects on initial choice of dialysis modality, but this choice did not always lead to the best results. Further analyses of the pattern of choosing dialysis modality according to baseline comorbid conditions and related consequent mortality outcomes are needed.
AB - Background/Aims: Since comorbidities are major determinants of modality choice, and also interact with dialysis modality on mortality outcomes, we examined the pattern of modality choice according to comorbidities and then evaluated how such choices affected mortality in incident dialysis patients. Methods: We analyzed 32,280 incident dialysis patients in Korea. Patterns in initial dialysis choice were assessed by multivariate logistic regression analyses. Multivariate Poisson regression analyses were performed to evaluate the effects of interactions between comorbidities and dialysis modality on mortality and to quantify these interactions using the synergy factor. Results: Prior histories of myocardial infarction (p = 0.031), diabetes (p = 0.001), and congestive heart failure (p = 0.003) were independent factors favoring the initiation with peritoneal dialysis (PD), but were associated with increased mortality with PD. In contrast, a history of cerebrovascular disease and 1-year increase in age favored initiation with hemodialysis (HD) and were related to a survival benefit with HD (p < 0.001, both). While favoring initiation with HD, having Medical Aid (p = 0.001) and male gender (p = 0.047) were related to increased mortality with HD. Furthermore, although the severity of comorbidities did not inf luence dialysis modality choice, mortality in incident PD patients was significantly higher compared to that in HD patients as the severity of comorbidities increased (p for trend < 0.001). Conclusions: Some comorbidities exerted independent effects on initial choice of dialysis modality, but this choice did not always lead to the best results. Further analyses of the pattern of choosing dialysis modality according to baseline comorbid conditions and related consequent mortality outcomes are needed.
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UR - http://www.scopus.com/inward/citedby.url?scp=85025173890&partnerID=8YFLogxK
U2 - 10.3904/kjim.2017.141
DO - 10.3904/kjim.2017.141
M3 - Article
C2 - 28651309
AN - SCOPUS:85025173890
VL - 32
SP - 699
EP - 710
JO - Korean Journal of Internal Medicine
JF - Korean Journal of Internal Medicine
SN - 1226-3303
IS - 4
ER -