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Dialysis modality and patient outcome

Lionel U Mailloux, MD, FACP
John M Burkart, MD
Section Editor
Jeffrey S Berns, MD
Deputy Editor
Alice M Sheridan, MD


Although the rate of all-cause mortality for dialysis patients remains higher than the general population, the life expectancy of patients with end-stage renal disease (ESRD) has gradually improved since the introduction of dialysis in the 1960s. According to the 2013 United States Renal Data System (USRDS) report, the adjusted 60-month survival probabilities measured from day 1 of therapy for all patients was 0.30 for the cohort starting in 1998 compared with 0.36 for the cohort starting in 2006 [1].

Previously, one partial explanation for the poor survival in the United States was inadequate dialysis since substantially higher survival rates have been reported in Europe and Japan, even after case adjustment for age, sex, and renal diagnoses [2]. Japanese patients, for example, have far fewer comorbid risk factors than those in the United States [3,4]. However, it is more likely that factors such as older age, a higher prevalence of diabetes mellitus, more comorbid conditions, and an inability to accurately capture severity of any noted comorbid disease are components of the higher dialysis mortality in the United States [5]. This is particularly true as an increasing dialysis dose has been realized in the United States [5].

One of the highest survival rates has been reported from Tassin, France, where patients are dialyzed 24 hours per week, much longer than in almost all other centers (figure 1) [6]. This and other observations have led to a general increase in time in the dialysis prescription in the United States.

In addition to increased duration of dialysis, it has been proposed that other factors also may improve patient outcome such as frequency of the dialysis treatment and middle-molecule clearance. (See "Prescribing and assessing adequate hemodialysis".)

This topic reviews the selection of dialysis modality and patient outcomes that are associated with specific modalities. Patient outcomes associated with dialysis adequacy, the use of daily or nocturnal hemodialysis, and the selection of different types of peritoneal dialysis are discussed elsewhere. (See "Patient survival and maintenance dialysis" and "Short daily hemodialysis" and "Sustained low efficiency or extended daily dialysis" and "Outcomes associated with nocturnal hemodialysis" and "Choosing a modality for chronic peritoneal dialysis".)

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Literature review current through: Nov 2017. | This topic last updated: Oct 02, 2017.
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