ArticleBMC nephrology2026
Hemodialysis versus peritoneal dialysis in elderly ESRD patients: a retrospective cohort study on survival and the role of comorbidities.
Article in BMC nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo compare survival differences between hemodialysis (HD) and peritoneal dialysis (PD) in elderly patients (≥ 60 years old) with end-stage renal disease (ESRD), and to analyze the impact of key comorbidities (heart failure, cerebrovascular disease, diabetes) on prognosis and causes of death, to inform dialysis modality selection.
methodsThis single-center retrospective cohort study enrolled 377 elderly ESRD patients (216 HD, 161 PD) who initiated dialysis between 2012 and 2017, with follow-up until 2024. Survival rates were compared using the Kaplan-Meier method. The Cox proportional hazards model was used to analyze risk factors for all-cause mortality, and the competing risks model was employed to assess risks for specific causes of death. Subgroup analyses were performed for patients with heart failure, cerebrovascular disease, and diabetes.
resultsIn the overall population, the HD group had a significantly lower risk of all-cause mortality than the PD group (adjusted HR = 0.599, 95% CI: 0.45–0.79). Subgroup analyses revealed that the survival advantage of HD was particularly pronounced in patients with concomitant heart failure (adjusted HR = 0.422, 95% CI: 0.25–0.70) or diabetes (adjusted HR = 0.687, 95% CI: 0.48–0.98). Notably, HD was identified as an independent risk factor for hemorrhagic death (sHR = 8.773, 95% CI: 1.03–74.42), with the PD group demonstrating a markedly lower cumulative incidence of such events.
conclusionFor elderly ESRD patients, dialysis modality selection should be individualized based on comorbidities. HD may be associated with a survival benefit and might be prioritized for patients with concomitant heart failure or diabetes. PD may be considered a safer option, particularly for patients with cerebrovascular disease who are at high risk of bleeding. CLINICAL TRIAL NUMBER: Not applicable.
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