Dialysis Survival after Graft Loss: Are We Finally Comparing “Apples to Apples”?

[摘要] The new paradigm in Nephrology is the individualization of patient care. A Kt/V of 1.2 may be enough for some but not for others (1), hemoglobin targets may not be appropriate if the patient is slow to respond and requires a high dose of erythropoietin (2), and in fact peritoneal dialysis (PD) may offer a survival advantage for some and not for others as an initial modality choice (3). Survival differences between PD and hemodialysis (HD) have been widely debated, with differences in outcomes influenced by variations in the cohorts, patients, and follow-up time. One persisting weakness in this literature is the adjustment for confounders such as the vascular access use, which has a significant association with increased mortality (4), and adjustment in functional difference between patients who can manage dialysis at home and those who require primarily in-center care. A recent comparison of HD patients on the transplant waiting list found no difference in survival compared with patients on PD, suggesting that the previous studies had some residual confounding (5).

[学科分类] 泌尿医学

[关键词] Bone marrow necrosis;Sickle cell disease;Hyperhemolysis syndrome