Current evidence shows that survival outcomes are equivalent for dialysis techniques
La evidencia actual demuestra una equivalencia de resultados entre las técnicas de diálisis
Read
9222
Timeswas read the article
2371
Total PDF
6851
Total HTML
Share statistics
array:21 [ "pii" => "X2013251411052588" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.May.10872" "estado" => "S300" "fechaPublicacion" => "2011-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:520-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 5300 "formatos" => array:3 [ "EPUB" => 300 "HTML" => 4321 "PDF" => 679 ] ] "Traduccion" => array:1 [ "es" => array:17 [ "pii" => "X0211699511052580" "issn" => "02116995" "doi" => "10.3265/Nefrologia.pre2011.May.10872" "estado" => "S300" "fechaPublicacion" => "2011-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia. 2011;31:520-7" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 8834 "formatos" => array:3 [ "EPUB" => 271 "HTML" => 8039 "PDF" => 524 ] ] "es" => array:12 [ "idiomaDefecto" => true "titulo" => "La evidencia actual demuestra una equivalencia de resultados entre las técnicas de diálisis" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "520" "paginaFinal" => "527" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Current evidence shows that survival outcomes are equivalent for dialysis techniques" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10872_108_17602_es_10872_t1.jpg" "Alto" => 728 "Ancho" => 505 "Tamanyo" => 381760 ] ] "descripcion" => array:1 [ "es" => "Conclusiones heterogéneas en los estudios de supervivencia comparada entre hemodiálisis y diálisis peritoneal" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "C. Remón Rodríguez, P.L. Quirós Ganga" "autores" => array:3 [ 0 => array:2 [ "Iniciales" => "C." "apellidos" => "Remón Rodríguez" ] 1 => array:2 [ "Iniciales" => "C." "apellidos" => "Remón Rodríguez" ] 2 => array:2 [ "Iniciales" => "P.L." "apellidos" => "Quirós Ganga" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "X2013251411052588" "doi" => "10.3265/Nefrologia.pre2011.May.10872" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052588?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052580?idApp=UINPBA000064" "url" => "/02116995/0000003100000005/v0_201502091408/X0211699511052580/v0_201502091408/es/main.assets" ] ] "itemSiguiente" => array:17 [ "pii" => "X201325141105257X" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Aug.11012" "estado" => "S300" "fechaPublicacion" => "2011-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:528-36" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 9912 "formatos" => array:3 [ "EPUB" => 312 "HTML" => 8721 "PDF" => 879 ] ] "en" => array:12 [ "idiomaDefecto" => true "titulo" => "Economic impact of vitamin D treatment on chronic kidney disease patients" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "528" "paginaFinal" => "536" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Impacto económico del tratamiento con vitamina D en pacientes con enfermedad renal crónica" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "11012_108_21951_en_f1_11012i.jpg" "Alto" => 408 "Ancho" => 600 "Tamanyo" => 157134 ] ] "descripcion" => array:1 [ "en" => "Vitamina D Action" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Ramos, R. Alcázar, A. Otero, A.L.M. de Francisco, M.D. del Pino" "autores" => array:5 [ 0 => array:2 [ "Iniciales" => "R." "apellidos" => "Ramos" ] 1 => array:2 [ "Iniciales" => "R." "apellidos" => "Alcázar" ] 2 => array:2 [ "Iniciales" => "A." "apellidos" => "Otero" ] 3 => array:2 [ "nombre" => "A.L.M." "apellidos" => "de Francisco" ] 4 => array:2 [ "Iniciales" => "M.D." "apellidos" => "del Pino" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699511052572" "doi" => "10.3265/Nefrologia.pre2011.Aug.11012" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052572?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X201325141105257X?idApp=UINPBA000064" "url" => "/20132514/0000003100000005/v0_201502091634/X201325141105257X/v0_201502091634/en/main.assets" ] "itemAnterior" => array:17 [ "pii" => "X2013251411052596" "issn" => "20132514" "doi" => "10.3265/Nefrologia.pre2011.Jun.10926" "estado" => "S300" "fechaPublicacion" => "2011-09-01" "documento" => "article" "licencia" => "http://www.elsevier.com/open-access/userlicense/1.0/" "subdocumento" => "fla" "cita" => "Nefrologia (English Version). 2011;31:514-9" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 6887 "formatos" => array:3 [ "EPUB" => 292 "HTML" => 5599 "PDF" => 996 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Chronic kidney disease-mineral and bone disorder: a complex scenario" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "514" "paginaFinal" => "519" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "El complejo escenario de las alteraciones de metabolismo óseo y mineral en la enfermedad renal crónica" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Natalia Mejia, N. Mejía, Pablo Roman-Garcia, P. Roman-García, Ana Belen Miar, A.B. Miar, Beatriz Tavira, B. Tavira, Jorge B Cannata-Andía, J.B. Cannata-Andía" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Natalia" "apellidos" => "Mejia" ] 1 => array:2 [ "Iniciales" => "N." "apellidos" => "Mejía" ] 2 => array:2 [ "nombre" => "Pablo" "apellidos" => "Roman-Garcia" ] 3 => array:2 [ "Iniciales" => "P." "apellidos" => "Roman-García" ] 4 => array:2 [ "nombre" => "Ana Belen" "apellidos" => "Miar" ] 5 => array:2 [ "Iniciales" => "A.B." "apellidos" => "Miar" ] 6 => array:2 [ "nombre" => "Beatriz" "apellidos" => "Tavira" ] 7 => array:2 [ "Iniciales" => "B." "apellidos" => "Tavira" ] 8 => array:2 [ "nombre" => "Jorge B" "apellidos" => "Cannata-Andía" ] 9 => array:2 [ "Iniciales" => "J.B." "apellidos" => "Cannata-Andía" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "X0211699511052599" "doi" => "10.3265/Nefrologia.pre2011.Jun.10926" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X0211699511052599?idApp=UINPBA000064" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052596?idApp=UINPBA000064" "url" => "/20132514/0000003100000005/v0_201502091634/X2013251411052596/v0_201502091634/en/main.assets" ] "en" => array:15 [ "idiomaDefecto" => true "titulo" => "Current evidence shows that survival outcomes are equivalent for dialysis techniques" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "520" "paginaFinal" => "527" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "C. Remón Rodríguez, P.L. Quirós Ganga" "autores" => array:3 [ 0 => array:4 [ "Iniciales" => "C." "apellidos" => "Remón Rodríguez" "email" => array:1 [ 0 => "cesarkai@telefonica.net" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] ] ] 1 => array:4 [ "Iniciales" => "C." "apellidos" => "Remón Rodríguez" "email" => array:1 [ 0 => "cesarkai@telefonica.net" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] 2 => array:3 [ "Iniciales" => "P.L." "apellidos" => "Quirós Ganga" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Nefrología, Hospital Universitario Puerto Real Cádiz Spain, " "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "affa" ] 1 => array:3 [ "entidad" => "Unidad de Gestión Clínica de Nefrología, Hospital Universitario Puerto Real, Cádiz " "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "affb" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La evidencia actual demuestra una equivalencia de resultados entre las técnicas de diálisis" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10872_108_21887_en_t1.jpg" "Alto" => 846 "Ancho" => 600 "Tamanyo" => 307783 ] ] "descripcion" => array:1 [ "en" => "Heterogeneous conclusions in survival studies comparing haemodialysis and peritoneal dialysis" ] ] ] "textoCompleto" => "<p class="elsevierStylePara"><span class="elsevierStyleBold">A CONFUSING SITUATION</span></p><p class="elsevierStylePara">We are aware that medical factors are not the main determining factors for choosing which dialysis technique to use, which are funding and the unit’s or centre’s knowledge and experience. However, we must find out the actual differences in survival outcomes for each of the methods,<span class="elsevierStyleSup">1</span> so that scientific evidence can be used to support treatment choices, along with the patient’s clinical circumstances, preferences and lifestyle.</p><p class="elsevierStylePara">Peritoneal dialysis (PD) and haemodialysis (HD) results have been subject to several studies over recent years. The conclusions from these studies have been heterogeneous and on many occasions confusing, so much so that no significant or very slight differences have been found in favour of one technique or another (Table 1). This is due to multiple factors such as using records from very heterogeneous populations (single centre, multicentre, and even national), different study designs, incident or prevalent populations, and comparisons between studies regarding the necessary comorbidity adjustments.<span class="elsevierStyleSup">2</span></p><p class="elsevierStylePara">Some authors have even started to question how two so different techniques, such as HD and PD, can be compared,<span class="elsevierStyleSup">3,4</span> with the type of studies that are available.</p><p class="elsevierStylePara">As such, all comparative reviews of survival rates for these dialysis techniques must consider the methodological characteristics or attributes that should be included in good studies.<span class="elsevierStyleSup">5</span> The second section of this study will discuss this matter.</p><p class="elsevierStylePara">Therefore, and following this standard practice, we shall discuss at great length the main classic studies’ results (incident populations before 2002), that are well designed and which compare both replacement therapies. We also present the conclusions from new studies (incident populations after 2002) as well from our own research.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">METHODOLOGICAL ATTRIBUTES RECOMMENDED FOR STUDIES COMPARING HAEMODIALYSIS AND PERITONEAL DIALYSIS</span></p><p class="elsevierStylePara">It is well known that controlled and randomised studies provide the most scientific evidence. However, we have only found one study with these characteristics that compares dialysis techniques in the literature, and it had poor extrapolative results due to an unsuccessful inclusion of patients.<span class="elsevierStyleSup">6</span></p><p class="elsevierStylePara">Following the level of evidence scale, the observational prospective cohort studies would, in principle, have to be well designed to be able to assess the differences between HD and PD in the long term. However, there are very few of them, given that their prospective design would not allow treatment transfers or substantial modifications in techniques, so as not to alter the final result. Furthermore, they need to use large samples, population subgroups, as well as long follow-up, etc.</p><p class="elsevierStylePara">Therefore, for this type of analysis, observational studies of registries with large cohorts of patients are mostly used. They must take into account certain important considerations.</p><p class="elsevierStylePara">Incident patient populations should be analysed, because if we include prevalent patients, then early mortality is excluded. This would therefore have an effect on the PD outcome, and would produce a significant bias.<span class="elsevierStyleSup">7,8</span></p><p class="elsevierStylePara">Populations can influence the results depending on their geographical origin, demographic or risk characteristics, health systems, or centres’ experience. Furthermore, results are not easily extrapolated to different populations.<span class="elsevierStyleSup">9</span></p><p class="elsevierStylePara">Statistically analysing these comparisons is complex and includes clinically important interactions, which have already been identified in several studies: the relative risk (RR) for survival-related events between PD and HD changes over time, according to age, diabetes and comorbidity. As such, PD-treated patients are at lower risk during the first years of dialysis, which is more apparent in younger, non-diabetic patients that do not have associated diseases.</p><p class="elsevierStylePara">Intention-to-treat statistical analysis should be performed to stop transfers from influencing the results. But ideally both intention-to-treat and non-intention-to-treat analyses should be used.</p><p class="elsevierStylePara">The most used statistical techniques for these analyses are Kaplan-Meier curves and Cox regression.<span class="elsevierStyleSup">10,11</span> The latter allows us to perform multivariate corrections and adjustments for comorbidities, as also occurs for the Poisson regression. All of which reach similar results in studies comparing PD and HD survival outcomes.<span class="elsevierStyleSup">12</span></p><p class="elsevierStylePara">Finally, we must mention that the adjustment for comorbidities must be as wide as possible, and it must include factors that are more widely known for their influence on patient survival, such as older age, diabetes mellitus and cardiovascular disease.<span class="elsevierStyleSup">13,14</span> That is why the absence of some of these adjustments in the analysis leads to an important bias and incorrect results.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">MAIN RESULTS OF CLASSIC STUDIES (INCIDENT POPULATIONS BEFORE 2002)</span></p><p class="elsevierStylePara">We have analysed nine of the most relevant studies with incident populations before 2002, which fulfil the recommended methodological attributes described, identifying some key results that must be commented on.</p><p class="elsevierStylePara">When comparing survival between HD- and PD-treated patients, there are no great overall differences, and large registry-based studies and prospective cohorts behave in a similar manner. Vonesh published a study in 2006 on large registry-based studies (Table 2) which showed that when the differences between the populations are adjusted, the outcomes are very similar among these studies.<span class="elsevierStyleSup">5,15</span> The main prospective cohorts (Table 2) are NECOSAD (Dutch),<span class="elsevierStyleSup">16</span> the Canadian study by Murphy,<span class="elsevierStyleSup">17</span> and the CHOICE study.<span class="elsevierStyleSup">18</span> No significant differences are found between the NECOSAD and the Murphy studies and the Dutch and Canadian registries. The CHOICE study presents some very conflicting results compared with the prognosis of the same patient subgroups from the US Medicare population. This could be explained by the low statistical power that this study has, and by the severe bias in choosing participating centres (90% were recruited from a single provider).</p><p class="elsevierStylePara">When a stratification and adjustment for comorbidities is performed, PD presents an equivalent or better prognosis in groups of younger, non-diabetic patients with a less comorbidities scores, in almost all publications.<span class="elsevierStyleSup">14,19</span></p><p class="elsevierStylePara">However, HD, especially in studies with American populations, and slightly less in Dutch studies, presents a better survival prognosis for older, diabetic patients, with worse cardiovascular diseases. The American registry states that age is relevant to patients over 45 years old and the Dutch register over 60 years old.</p><p class="elsevierStylePara">When considering the time that patients have been undergoing dialysis treatment, we must point out that all studies show that initial survival is greater for PD. Some analyses<span class="elsevierStyleSup">15 </span>show that this difference decreases over time, and that HD is more favourable than PD after the first or second year, whereas others show that this initial advantage is maintained over a longer period, and even that there are no significant differences in favour of HD not even at the end of the follow-up, as is shown in the Danish registry<span class="elsevierStyleSup">20</span>or in the Canadian registry published by Fenton in 1997,<span class="elsevierStyleSup">21</span> and later by Yeates in 2008.<span class="elsevierStyleSup">22</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">MAIN RESULTS OF RECENT STUDIES (INCIDENT POPULATIONS AFTER 2002)</span></p><p class="elsevierStylePara">The ANZDATA<span class="elsevierStyleSup">23</span> Registry (Australia and New Zealand registry) has an incident population of 25 287 patients from 1991 to 2005 (HD: 14 733; DP: 10 554). Adjusted for age, sex, body mass index (BMI), diabetes and comorbidity, it shows similar results to other, above mentioned studies that compare HD:PD survival. This registry also shows that PD is better for all diabetic patients and non-diabetic patients, of any age, but only until the second year. In the third and forth year HD has a better prognosis. Similarly, the patient’s age and comorbidities influence the results almost identically to previous studies.</p><p class="elsevierStylePara">A very recent publication<span class="elsevierStyleSup">24 </span>from 2011 the European Renal Registry Investigators (ERA-EDTA) analyses comparative survival rates for incident populations from 1999 to 2003, adjusted for age, sex, and underlying kidney disease. Its results are the same: the PD-treated population had a better survival outcome than HD patients, which was maintained until the third year, and HD was slightly better in the forth and fifth years.</p><p class="elsevierStylePara">In 2010, Weinhandl et al<span class="elsevierStyleSup">25</span> published the results from a retrospective cohort of incident patients from 2003 in the USA (n=98 875) comparing the survival rates for both techniques, HD (n=92 187) and PD (n=6688). To do so, they designed a methodology which matched DP patients with their HD pairs according to factors such as age, sex, race, underlying kidney disease, laboratory data and most important comorbidity. Six thousand three-hundred and thirty-seven propensity-matched pairs were therefore obtained and followed until December 2006. Two types of intention-to-treat analyses were performed: one taking into account the type of dialysis on day 0 of replacement therapy, and the other on day 90. Later, subgroups according to age, cardiovascular disease and diabetes were created. In the analysis which considers the technique on day 0, the cumulative death risk at 4 years was 8% less for PD (<span class="elsevierStyleItalic">P</span><.04). This difference was more important for patients under 65 years, with no cardiovascular disease and diabetes, and similar for patients over this age, with cardiovascular disease and diabetes. In the analysis for survival after 90 days, survival was also greater for PD patients than HD patients, with no statistical significance.</p><p class="elsevierStylePara">In the last decade we have observed an improvement in the vital prognosis of dialysis-treated patients, especially for PD patients. This is also shown in the <span class="elsevierStyleItalic">Registro Español de Enfermos Renales </span>(Spanish Registry of Renal Patients), in which the gross mortality rate has improved for PD patients in recent years. However, HD rates have not considerably changed, which is also described by Mehrotra et al<span class="elsevierStyleSup">26</span> in the USA registry in which prognosis improved significantly for patients treated between 2000-2003, compared to those from 1996-1997, with the same comorbidity and laboratory adjustments.</p><p class="elsevierStylePara">Likewise, this has been shown for the European population, e.g. in the ERA-EDTA study of 2009, published by Kramer et al<span class="elsevierStyleSup">27</span> in which PD survival at 2 years improved by 19% in the second period studied (2002-2006), compared to the first period (1997-2001). However, it continued to remain stable for HD during the same periods. This study is lacking good risk adjustments and stratification. Lastly, in the above mentioned ANZDATA<span class="elsevierStyleSup">23</span> Registry the results reported are almost the same.</p><p class="elsevierStylePara">The recent Mehrotra et al<span class="elsevierStyleSup">28</span> study of 2010 (USA registry) deserves a more detailed analysis. It compares 3 cohorts related to the periods 1996-1998, 1999-2001 and 2002-2004. For the first time in an American cohort, no significant overall differences in PD and HD survival were detected after five years of follow-up using an intention-to-treat analysis. Subgroups stratified by age, diabetes and comorbidity had similar outcomes: PD had a better prognosis for younger, non-diabetic patients with no comorbidity, and HD was better for those over 65, with comorbidities and diabetes. Both extreme situations presented significance in its advantages for each technique. In the intermediate situations, there are no differences in favour or against either of the dialysis techniques (Figure 1).</p><p class="elsevierStylePara">We have also observed this improvement in PD outcomes during recent years for the population treated in Andalusia, with adjustments for age, cardiovascular disease and diabetes. We observed a significantly better survival for incident patients from 2004 to 2008 compared to those from 1999 to 2003 (Figure 2).</p><p class="elsevierStylePara">Better PD results in more recent studies are likely the result of better peritoneal membrane protection as more biocompatible solutions, fewer high glucose concentrations and more adequate doses are used. In addition, centres are better experienced, volumes are better handled and complications, such as peritonitis, are more adequately treated.</p><p class="elsevierStylePara">As has been mentioned above, and based on multivariate analyses, we can state that the survival of patients on dialysis is much more influenced by the conditions at the start of the technique, (i.e. age, diabetes, cardiovascular disorder) than the type of technique itself.</p><p class="elsevierStylePara">We know that the multivariate regression allows us to determine independent variables that influence the final results separately and that the ROC curves graphically represent the percentage of the phenomenon or the event studied (in this case death) which is explained by the variables considered (area under the curve). Therefore, by comparing different multivariate models created with more or less variables (or different variables) on a same outcome, we are able to find out which better explains the phenomenon. The aim is to find an efficient study and statistical method, i.e. find an adequate percentage to explain the result (always >50%) with the fewest variables possible. Therefore, a model with 3 variables which expresses a very similar percentage to one with 10 or 15 variables would be more efficient.</p><p class="elsevierStylePara">Using this methodology (Figure 3), we have analysed that the prognostic variable for death created by the group of risk factors present at the start of this technique, (age and cardiovascular disease and diabetes and the other comorbidities considered in the Charlson’s comorbidity index) would explain the 81.6% prediction in the multivariate model in our PD population. The variable created by age and cardiovascular disorder and diabetes would explain 80.7% (a difference of 0.9%).</p><p class="elsevierStylePara">Therefore, when statistically examining the probability of death, depending on certain independent comorbidity variables, including age (as a continuous variable), cardiovascular disorder and diabetes in this multivariate model is the most efficient technique. We can forget all the other variables included in Charlson’s index, as they would not provide very much information to the final prediction and would make data collection and analysis unnecessarily more complicated.</p><p class="elsevierStylePara">Therefore, there is very little margin for other variables such as the dialysis type and dose, anaemia, nutrition, etc., factors that undoubtedly influence outcomes, but whose absolute weighing is quite marginal. Furthermore, some are intermediate variables conditioned by the fundamental initial comorbidity.</p><p class="elsevierStylePara"><span class="elsevierStyleBold">CONCLUSIONS</span></p><p class="elsevierStylePara">Following these reflections, we have to conclude that survival outcomes of these dialysis techniques are equivalent, that their long-term results are similar and that fundamentally, the associated factors are those that have a greater impact on mortality for dialysis patients.<span class="elsevierStyleSup">29</span> The health centre’s experience with each therapy,<span class="elsevierStyleSup">30</span> and some patient conditions can influence these results, such as age, diabetes, therapeutic adherence, urgent or programmed dialysis, associated comorbidity, dialysis access complications, etc. Factors that determine a shorter survival, both for PD and HD patients, seem to be well defined and are similar for both therapies. Older age, diabetes mellitus and atherosclerosis-induced complications seem definitive<span class="elsevierStyleSup">31</span> and would explain, by a wide margin, most of the deaths in multivariate models, being more related to survival than the dialysis technique itself.<span class="elsevierStyleSup">32</span> Finally, time seems to have an important and well-demonstrated impact on outcomes, so much so that during the first years, patients with PD have a better prognosis than those undergoing HD, especially younger patients with fewer comorbidities. Furthermore, more recent patient cohorts have also had a very similar prognosis for the two therapies in the medium term, and PD results have improved during the past decade.</p><p class="elsevierStylePara"><a href="grande/10872_108_21887_en_t1.jpg" class="elsevierStyleCrossRefs"><img src="10872_108_21887_en_t1.jpg" alt="Heterogeneous conclusions in survival studies comparing haemodialysis and peritoneal dialysis"></img></a></p><p class="elsevierStylePara">Table 1. Heterogeneous conclusions in survival studies comparing haemodialysis and peritoneal dialysis</p><p class="elsevierStylePara"><a href="grande/10872_108_21888_en_t2.jpg" class="elsevierStyleCrossRefs"><img src="10872_108_21888_en_t2.jpg" alt="Main results from classic studies"></img></a></p><p class="elsevierStylePara">Table 2. Main results from classic studies</p><p class="elsevierStylePara"><a href="grande/10872_108_21889_en_f1.jpg" class="elsevierStyleCrossRefs"><img src="10872_108_21889_en_f1.jpg"></img></a></p><p class="elsevierStylePara">Figure 1. </p><p class="elsevierStylePara"><a href="grande/10872_108_21890_en_f2r.jpg" class="elsevierStyleCrossRefs"><img src="10872_108_21890_en_f2r.jpg" alt="Improvement in PD prognosis in our environment during recent years"></img></a></p><p class="elsevierStylePara">Figure 2. Improvement in PD prognosis in our environment during recent years</p><p class="elsevierStylePara"><a href="grande/10872_108_21891_en_f3.jpg" class="elsevierStyleCrossRefs"><img src="10872_108_21891_en_f3.jpg" alt="Sensitivity and specificity study using ROC curves (see text.) "></img></a></p><p class="elsevierStylePara">Figure 3. Sensitivity and specificity study using ROC curves (see text.) </p>" "pdfFichero" => "P1-E524-S3347-A10872-EN.pdf" "tienePdf" => true "PalabrasClave" => array:2 [ "es" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440481" "palabras" => array:1 [ 0 => "Análisis estadístico" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440483" "palabras" => array:1 [ 0 => "Diálisis peritoneal" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440485" "palabras" => array:1 [ 0 => "Hemodiálisis" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec440488" "palabras" => array:1 [ 0 => "Supervivencia" ] ] ] "en" => array:4 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440482" "palabras" => array:1 [ 0 => "Statistical analysis" ] ] 1 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440484" "palabras" => array:1 [ 0 => "Peritoneal dialysis" ] ] 2 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440486" "palabras" => array:1 [ 0 => "Haemodialysis" ] ] 3 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec440489" "palabras" => array:1 [ 0 => "Survival" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<p class="elsevierStylePara">Los estudios que han analizado la supervivencia entre hemodiálisis y diálisis peritoneal han sido hasta ahora heterogéneos, con resultados a favor de una u otra técnica, y en muchos casos, confusos, lo que depende también de numerosos factores. Por dicho motivo, es necesario conocer si existen diferencias reales entre las dos modalidades, para situar a la evidencia científica como pilar fundamental en la elección del tratamiento, junto con las circunstancias clínicas de los pacientes concretos, sus preferencias y estilo de vida. Una revisión comparativa de la supervivencia entre técnicas de diálisis no puede eludir unas características o atributos metodológicos básicos, como ser de diseños adecuados, como los estudios observacionales de registros con grandes cohortes, con poblaciones incidentes y no prevalentes, con análisis por intención de tratar, análisis de supervivencia y análisis multivariantes con ajustes de las principales comorbilidades. Se han revisado los nueve estudios clásicos (poblaciones incidentes previas al año 2002) principales, que presentan unas conclusiones similares: globalmente no existen grandes diferencias entre las técnicas, con un comportamiento similar tanto en los grandes registros como en las cohortes prospectivas. Cuando se realizan una estratificación y un ajuste por comorbilidades, la diálisis peritoneal presenta un pronóstico equivalente o mejor en los grupos de pacientes no diabéticos, menos comórbidos y más jóvenes, prácticamente en todas las publicaciones, y la hemodiálisis en los diabéticos, de mayor edad y más comórbidos. De la misma forma, se detallan los resultados de los estudios recientes (que incluyen poblaciones incidentes posteriores al 2002), que llegan a la conclusión de que existe un comportamiento similar para la supervivencia entre hemodiálisis y diálisis peritoneal. De igual manera, la edad y la comorbilidad del paciente influyen en los resultados de forma casi idéntica a lo publicado en los estudios anteriores. En la última década hemos asistido en una mejora del pronóstico vital de los pacientes tratados en diálisis, más importante en los pacientes en diálisis peritoneal, tanto en EE.UU. como en Europa, Australia y también en España (análisis propio en Andalucía). Finalmente, y por medio de análisis multivariantes propios, podemos afirmar que la supervivencia del paciente en diálisis se ve mucho más influida por las condiciones al inicio de la técnica, como la edad, la presencia de diabetes o la enfermedad cardiovascular, que por el tipo de técnica en sí.</p>" ] "en" => array:1 [ "resumen" => "<p class="elsevierStylePara"><span class="elsevierStyleItalic">Studies that have analyzed survival between hemodialysis and peritoneal dialysis have showed heterogeneous outcomes for both techniques, and often confusing, also dependent on many factors. For this reason, it is necessary to know if there are real differences between the two treatments, to put the scientific evidence as a fundamental pillar in the choice of treatment, along with the clinical circumstances of individual patients, preferences and lifestyle of these. A comparative review of survival among dialysis techniques cannot avoid a basic methodological characteristics or attributes, such as appropriate designs such as observational studies with large cohorts, with incidents and no prevalent populations, with "intent to treat analysis "survival analysis and multivariate analysis with adjustments to the main comorbidity. We studied the nine classical main studies (incidents before 2002), presenting similar conclusions: there are no major differences between the techniques outcomes. When performing a stratification and adjustment for comorbidities, peritoneal dialysis has a equivalent or better prognosis in the nondiabetic group, less comorbidity and younger, almost all the publications, and hemodialysis in diabetics, older and more comorbid groups. The recent studies (including incidents after 2002), concluding a similar behavior for the survival HD: DP. Similarly, age and comorbidity influence the patient's outcomes almost identical to previous studies. In the last decade has seen an improvement in the prognosis of patients on dialysis, more pronounced in PD patients, both in the U.S., and Europe, Australia and in Spain (Andalusia analysis also). Finally, by multivariate analysis, we can show that patient survival on dialysis is much more influenced by conditions at the beginning of the treatment, as age, presence of diabetes or cardiovascular disease, rather than the type of technique of dialysis.</span></p> <p class="elsevierStylePara"><span class="elsevierStyleItalic"> </span></p>" ] ] "multimedia" => array:5 [ 0 => array:8 [ "identificador" => "fig1" "etiqueta" => "Tab. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10872_108_21887_en_t1.jpg" "Alto" => 846 "Ancho" => 600 "Tamanyo" => 307783 ] ] "descripcion" => array:1 [ "en" => "Heterogeneous conclusions in survival studies comparing haemodialysis and peritoneal dialysis" ] ] 1 => array:8 [ "identificador" => "fig2" "etiqueta" => "Tab. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10872_108_21888_en_t2.jpg" "Alto" => 342 "Ancho" => 600 "Tamanyo" => 716764 ] ] "descripcion" => array:1 [ "en" => "Main results from classic studies" ] ] 2 => array:7 [ "identificador" => "fig3" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10872_108_21889_en_f1.jpg" "Alto" => 348 "Ancho" => 600 "Tamanyo" => 114394 ] ] ] 3 => array:8 [ "identificador" => "fig4" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10872_108_21890_en_f2r.jpg" "Alto" => 422 "Ancho" => 600 "Tamanyo" => 103331 ] ] "descripcion" => array:1 [ "en" => "Improvement in PD prognosis in our environment during recent years" ] ] 4 => array:8 [ "identificador" => "fig5" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "copyright" => "Elsevier España" "figura" => array:1 [ 0 => array:4 [ "imagen" => "10872_108_21891_en_f3.jpg" "Alto" => 498 "Ancho" => 600 "Tamanyo" => 118684 ] ] "descripcion" => array:1 [ "en" => "Sensitivity and specificity study using ROC curves (see text.)" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:32 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Foley RN, Parfrey PS, Harnett JD, Kent GM, O'Dea R, Murray DC, et al. Mode of dialysis therapy and mortality in end-stage renal disease. J Am Soc Nephrol 1998;9:267-76. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9527403" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Ross S, Dong E, Gordon M, Connelly J, Kvasz M, Iyengar M, Mujais SK.\u{A0}Meta-analysis of outcome studies in edn-stage renal disease. Kidney Int 2000;57(Suppl\u{A0}74):S28-S38." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S073510970400169X" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Foley RN. Comparing the imcomparable: hemodialisys versus peritoneal dialysis in observational studies. Perit Dial Int 2004;24:217-21. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15185769" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Prichard SS. Peritoneal dialysis and haemodialysis: are they comparable? Nephrol Dial Transplant 1997;12(Suppl 1):65-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9075232" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "5.\u{A0}Vonesh EF,\u{A0}Snyder JJ,\u{A0}Foley RN,\u{A0}Collins AJ. Mortality studies comparing peritoneal dialysis and hemodialysis: what do they tell us? Kidney Int 2006;70: S3-S11." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 5 => array:3 [ "identificador" => "bib6" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "6.\u{A0}Korevaar RT, Feith GW, Dekker FW. Effect of starting with hemodialysis compared with peritoneal dialysis in patients new on dialysis treatment: a randomized controlled trial. Kidney Int 2003;64:2222-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14633146" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 6 => array:3 [ "identificador" => "bib7" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Bloembergen WE, Port FK, Mauger EA, Wolfe RA. A comparison of mortality between patients treated with hemodialysis and peritoneal dialysis. J Am Soc Nephrol 1995;6(2):177-83. \u{A0} <a href="http://www.ncbi.nlm.nih.gov/pubmed/7579082" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 7 => array:3 [ "identificador" => "bib8" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vonesh EF, Moran J. Mortality in end-stage renal disease: a reassessment of differences between patients treated with hemodialysis and peritoneal dialysis. J Am Soc Nephrol 1999;10:354-65. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10215336" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 8 => array:3 [ "identificador" => "bib9" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Canada-USA (CANUSA) Peritoneal dialysis Study Group. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol 1996;7:198-207. <a href="http://www.ncbi.nlm.nih.gov/pubmed/8785388" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 9 => array:3 [ "identificador" => "bib10" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Van Biesen W, Vanholder R, Debacquer D, De Backer G, Lameire NT.. Comparison of survival on CAPD and haemodialysis: statistical pitfalls. Nephrol Dial Transplant 2000;15:307-11." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 10 => array:3 [ "identificador" => "bib11" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Keshaviah P, Collins AJ, Ma JZ, Umen A, Keshaviah P. Survival comparison between hemodialysis and peritoneal dialysis based on matched doses of delivered therapy. J Am Soc Nephrol 2002;13:S48-S52. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11792762" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 11 => array:3 [ "identificador" => "bib12" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vonesh EF, Schauble DE, Hao W. Staticals methods for comparing mortality among ESRD patients: examples of regional/international variations. Kidney Int 2000;57(Suppl 74):S19-S27." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 12 => array:3 [ "identificador" => "bib13" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Xue JL, Everson SE, Constantini EG, Ebben JP, Chen SC, Agodoa LY, et al. Peritoneal and hemodialysis II: mortality risk associated with initial patient characteristics. Kidney Int 2002;61:741-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11849418" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S1933287407002917" "estado" => "S300" "issn" => "19332874" ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib14" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Vonesh EF, Snyder JJ, Foley RN, Collins AJ. The differential impact for risk factors on mortality in hemodialysis and peritoneal dialysis. Kidney Int 2004;66:2389-401. <a href="http://www.ncbi.nlm.nih.gov/pubmed/15569331" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 14 => array:3 [ "identificador" => "bib15" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Van Manen JF, Van Dijk PC, Stel V. Confoundign effect of comorbidity in survival studies in patients on renal replacement therapy. Nephro Dial Transplant 2007;22:187-95." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 15 => array:3 [ "identificador" => "bib16" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Termorshuizen F, Korevaar JC, Dekker FW, Van Manen JG, Boeschoten EW, Krediet RT. Hemodialysis and peritoneal dialysis: comparison of adjusted mortality rates according to the duration of dialysis: analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis 2. J Am Soc Nephrol 2003;14:2851-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/14569095" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 16 => array:3 [ "identificador" => "bib17" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "17.\u{A0}Murphy SW, Foley RN, Barrett BJ, Kent GM, Morgan J, Barre P, et al. Comparative mortality of hemodialysis and peritoneal dialysis in Canada. Kidney Int 2000;57:1720-6. <a href="http://www.ncbi.nlm.nih.gov/pubmed/10760108" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 17 => array:3 [ "identificador" => "bib18" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Miskulin DC, Meyer KB, Athienites NV, Martin AA, Terrin N, Marsh JV,\u{A0}et al. Comorbidity and other factors associated with modality selection in incident dialysis patients: The CHOICE study. Am J Kidney Dis 2002;39:324-36. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11840373" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 18 => array:3 [ "identificador" => "bib19" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "19.\u{A0}Liem YS, Wong JB, Hunink MGM, De Charro FTh, Winkel-Mayer WC. Comparison of hemodialysis and peritoneal dialysis survival in The Netherlands. Kidney Int 2007;71:153-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17136031" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:1 [ "itemHostRev" => array:3 [ "pii" => "S0735109711006115" "estado" => "S300" "issn" => "07351097" ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib20" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "20.\u{A0}Heaf JG, Lokkegaard H, Madsen M. Initial survival advantage of peritoneal dialysis relative to haemodialysis. Nephrol Dial Transplant 2002;17:112-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/11773473" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 20 => array:3 [ "identificador" => "bib21" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Fenton SSA, Schaubel DE, Desmeules M, Morrison HI, Mao Y, Copleston P, et al.\u{A0}Hemodialysis versus peritoneal dialysis: a comparison of adjusted mortality rates. Am J Kidney Dis 1997;30:334-42. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9292560" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 21 => array:3 [ "identificador" => "bib22" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Yeates KE, Zhu N, Vonesh E. Survival of patients receiving hemodialysis versis peritoneal dialysis in Canada: 1991-2000 with follov-up to 2005. J Am Soc Nephrol 2008;19:Abstract 279A." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 22 => array:3 [ "identificador" => "bib23" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "McDonald SP, Marshall MR, Johnson DW, Polkinghorne KR. Relationship between dialysis modality and mortality. J Am Soc Nephrol 2009;20:155-63. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19092128" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 23 => array:3 [ "identificador" => "bib24" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "24.\u{A0}Stel VS, Van de Luijtgaarden MWM,\u{A0}Wanner C.\u{A0}The 2008 ERA¿EDTA Registry Annual Report-a précis. NDT Plus 2011;4:1-13. <a href="http://www.ncbi.nlm.nih.gov/pubmed/21245934" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 24 => array:3 [ "identificador" => "bib25" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "25.\u{A0}Weinhandl ED, Foley RN, Gilbertson DT, Arneson TJ, Snyder JJ, Collins AJ.\u{A0}Propensity-matched mortality comparison of incident hemodialysis and peritoneal dialysis patients. J Am Soc Nephrol 2010;21:499-506. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20133483" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 25 => array:3 [ "identificador" => "bib26" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "26.\u{A0}Mehrotra R, Kermah D, Fried L, Kalantar-Zadeh K, Khawar O, Norris K,\u{A0}et al.\u{A0}Chronic peritoneal dialysis in the United States: declining utilization despite improving outcomes. J Am Soc Nephrol 2007;18:2781-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/17804675" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 26 => array:3 [ "identificador" => "bib27" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "27.\u{A0}Kramer A, Stel V, Zoccali C, Heaf J, Ansell D, Grönhagen-Riska C.\u{A0}An update on renal replacement therapy in Europe: ERA-EDTA Registry data from 1997 to 2006. Nephrol Dial Transplant 2009;24:3557-66. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19820003" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 27 => array:3 [ "identificador" => "bib28" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Mehrotra R, Chiu Y, Kalantar-Zadeh K.\u{A0}Similar outcomes with hemodialysis and peritoneal dialysis in patients with end-stage renal disease. Arch Intern Med. Disponible en www.archinternmed.com. Published online september 27, 2010." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 28 => array:3 [ "identificador" => "bib29" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Locatelli F, Marcelli D, Conte F. Dialysis patient outcomes in Europe vs the USA. Nephrol Dial Transplant 1997;12:1816-9. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9306326" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 29 => array:3 [ "identificador" => "bib30" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Huisman RM, Martin GM. Patients-related and centre-related factors influencing technique survival of peritoneal dialysis in The Netherlands. Nephrol Dial Transplant 2002;17:1655-60. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12198219" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 30 => array:3 [ "identificador" => "bib31" "etiqueta" => "31" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Maiorca R, Cancarini GC, Brunori G, Camerini C, Manili L. Morbidity and mortality of CAPD and hemodialysis. Kidney Int 1993;40(Supl):S4-S15." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 31 => array:3 [ "identificador" => "bib32" "etiqueta" => "32" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Jacobs C, Selwood NH. Long-term survival in dialysis patients: a demographric overview. En:\u{A0}Jacobs C, Kjellstrand CM, Koch KM, Winchester JF (eds.). Replacement of renal function by dialysis. Dordrecht: Kluwer Academic Publishers, 1996; pp. 1358-65." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000003100000005/v0_201502091634/X2013251411052588/v0_201502091634/en/main.assets" "Apartado" => array:4 [ "identificador" => "35446" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Special Originals" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000003100000005/v0_201502091634/X2013251411052588/v0_201502091634/en/P1-E524-S3347-A10872-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251411052588?idApp=UINPBA000064" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 7 | 8 | 15 |
| 2024 October | 48 | 42 | 90 |
| 2024 September | 42 | 27 | 69 |
| 2024 August | 68 | 48 | 116 |
| 2024 July | 36 | 21 | 57 |
| 2024 June | 60 | 42 | 102 |
| 2024 May | 65 | 26 | 91 |
| 2024 April | 63 | 34 | 97 |
| 2024 March | 48 | 23 | 71 |
| 2024 February | 47 | 38 | 85 |
| 2024 January | 50 | 18 | 68 |
| 2023 December | 30 | 24 | 54 |
| 2023 November | 26 | 35 | 61 |
| 2023 October | 41 | 23 | 64 |
| 2023 September | 34 | 28 | 62 |
| 2023 August | 27 | 22 | 49 |
| 2023 July | 40 | 28 | 68 |
| 2023 June | 39 | 21 | 60 |
| 2023 May | 41 | 34 | 75 |
| 2023 April | 22 | 18 | 40 |
| 2023 March | 39 | 24 | 63 |
| 2023 February | 34 | 24 | 58 |
| 2023 January | 26 | 36 | 62 |
| 2022 December | 72 | 30 | 102 |
| 2022 November | 51 | 43 | 94 |
| 2022 October | 55 | 39 | 94 |
| 2022 September | 53 | 45 | 98 |
| 2022 August | 46 | 42 | 88 |
| 2022 July | 37 | 42 | 79 |
| 2022 June | 52 | 44 | 96 |
| 2022 May | 78 | 25 | 103 |
| 2022 April | 54 | 51 | 105 |
| 2022 March | 55 | 57 | 112 |
| 2022 February | 47 | 39 | 86 |
| 2022 January | 27 | 30 | 57 |
| 2021 December | 37 | 40 | 77 |
| 2021 November | 46 | 35 | 81 |
| 2021 October | 42 | 33 | 75 |
| 2021 September | 39 | 44 | 83 |
| 2021 August | 36 | 33 | 69 |
| 2021 July | 32 | 44 | 76 |
| 2021 June | 29 | 21 | 50 |
| 2021 May | 38 | 36 | 74 |
| 2021 April | 45 | 49 | 94 |
| 2021 March | 58 | 35 | 93 |
| 2021 February | 57 | 17 | 74 |
| 2021 January | 49 | 19 | 68 |
| 2020 December | 52 | 17 | 69 |
| 2020 November | 37 | 18 | 55 |
| 2020 October | 35 | 16 | 51 |
| 2020 September | 38 | 9 | 47 |
| 2020 August | 43 | 11 | 54 |
| 2020 July | 46 | 12 | 58 |
| 2020 June | 41 | 18 | 59 |
| 2020 May | 54 | 20 | 74 |
| 2020 April | 35 | 15 | 50 |
| 2020 March | 53 | 12 | 65 |
| 2020 February | 58 | 19 | 77 |
| 2020 January | 68 | 26 | 94 |
| 2019 December | 63 | 20 | 83 |
| 2019 November | 66 | 28 | 94 |
| 2019 October | 39 | 7 | 46 |
| 2019 September | 43 | 22 | 65 |
| 2019 August | 28 | 6 | 34 |
| 2019 July | 41 | 24 | 65 |
| 2019 June | 39 | 22 | 61 |
| 2019 May | 29 | 18 | 47 |
| 2019 April | 50 | 37 | 87 |
| 2019 March | 25 | 17 | 42 |
| 2019 February | 65 | 17 | 82 |
| 2019 January | 36 | 19 | 55 |
| 2018 December | 85 | 37 | 122 |
| 2018 November | 79 | 21 | 100 |
| 2018 October | 72 | 15 | 87 |
| 2018 September | 90 | 15 | 105 |
| 2018 August | 58 | 20 | 78 |
| 2018 July | 64 | 20 | 84 |
| 2018 June | 32 | 11 | 43 |
| 2018 May | 60 | 14 | 74 |
| 2018 April | 45 | 9 | 54 |
| 2018 March | 57 | 7 | 64 |
| 2018 February | 50 | 6 | 56 |
| 2018 January | 55 | 10 | 65 |
| 2017 December | 66 | 8 | 74 |
| 2017 November | 57 | 6 | 63 |
| 2017 October | 37 | 8 | 45 |
| 2017 September | 52 | 12 | 64 |
| 2017 August | 61 | 10 | 71 |
| 2017 July | 59 | 10 | 69 |
| 2017 June | 57 | 9 | 66 |
| 2017 May | 58 | 9 | 67 |
| 2017 April | 52 | 11 | 63 |
| 2017 March | 31 | 37 | 68 |
| 2017 February | 66 | 21 | 87 |
| 2017 January | 49 | 13 | 62 |
| 2016 December | 80 | 15 | 95 |
| 2016 November | 100 | 15 | 115 |
| 2016 October | 132 | 7 | 139 |
| 2016 September | 169 | 10 | 179 |
| 2016 August | 224 | 5 | 229 |
| 2016 July | 208 | 13 | 221 |
| 2016 June | 151 | 0 | 151 |
| 2016 May | 129 | 0 | 129 |
| 2016 April | 105 | 0 | 105 |
| 2016 March | 82 | 0 | 82 |
| 2016 February | 134 | 0 | 134 |
| 2016 January | 96 | 0 | 96 |
| 2015 December | 140 | 0 | 140 |
| 2015 November | 102 | 0 | 102 |
| 2015 October | 83 | 0 | 83 |
| 2015 September | 80 | 0 | 80 |
| 2015 August | 94 | 0 | 94 |
| 2015 July | 97 | 0 | 97 |
| 2015 June | 37 | 0 | 37 |
| 2015 May | 57 | 0 | 57 |
| 2015 April | 7 | 0 | 7 |
Show all
