Peritoneal dialysis is associated with a better survival in cirrhotic patients with chronic kidney disease

Che Yi Chou, Shu Ming Wang, Chih Chia Liang, Chiz Tzung Chang, Jiung Hsiun Liu, I. Kuan Wang, Lien Cheng Hsiao, Chih Hsin Muo, Chi Jung Chung, Chiu Ching Huang*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

22 Scopus citations

Abstract

Peritoneal dialysis (PD) can be an ideal treatment in cirrhotic patients with ascites and chronic kidney disease stage 5 (CKD 5D) who require dialysis. The survival of cirrhotic patients with CKD 5D on PD, however, is not clear. We compared the survival of cirrhotic patients with CKD 5D on PD and the survival of those on HD. Two datasets including a cohort study of China Medical University Hospital (CMUH) from 2004 to 2013 and the Longitudinal National Health Insurance Database for Catastrophic Illness Patients (LHID-CIP) of Taiwan from 1996 to 2011 were analyzed. The survival of cirrhotic patients on PD and the propensity score matched cirrhotic patients on HD were analyzed using Cox proportional hazards regression. In CMUH cohort of 85 PD and 340 HD patients, the all-cause mortality was lower in PD patients compared to it in HDpatients (hazard ratio [HR]: 0.48, 95% confidence interval [CI]: 0.31-0.74, P<0.01) after adjustments for confounders. The severity of liver cirrhosis defined by Child-Turcotte-Pugh (CTP) class (P<0.01) was independently associated with all-cause mortality. The model for end-stage liver disease (MELD) score, however, was not associated with all-cause mortality. In the LHID-CIP cohort of 285 PD and 1140 HD patients, the HR of all-cause mortality in PD patients was 0.61 (95% CI: 0.47 - 0.79, P<0.01), as compared with HD patients. PD in cirrhotic patients who need dialysis is associated with lower all-cause mortality than HD is. This association is independent of patients' comorbidity, severity of liver cirrhosis, and serum albumin levels.

Original languageEnglish
JournalMedicine (United States)
Volume95
Issue number4
DOIs
StatePublished - 2016
Externally publishedYes

Bibliographical note

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Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.

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