Old age and diabetes mellitus lead to lower survival expectations in patients with end-stage renal disease (ESRD) on renal replacement therapy (RRT) (1 -7). Thus a progressive decline in five-year survival was observed with increasing age in total, diabetic, and nondiabetic patient populations accepted for RRT between 1982 and 1987, in the United States, Europe, and Japan (1). In the United States, diabetic patients with ESRD were found to have higher mortalityrates, irrespective of the modality of therapy or race. Adjusted one-year survival rate for diabetics was 74.2% as compared to 84.2% in glomerulonephritis in 1990 (2). Similar effects of age and diabetes mellitus on mortality rates were observed in the United States (3), Europe (4), Japan (5), Canada (6), and Australia and New Zealand (7). Major causes of death in the ESRD patient population were cardiovascular disease, infection, and withdrawal from dialysis (2,4,7).
Comorbid conditions on entrance to dialysis (8), quantity of dialysis (9–11), and transplantation rates (4, 12) have also been shown to affect overall survival results. Each of these factors needs to be carefully considered in any review of survival in dialysis, as differences in the conditions may change the outcome.
In this report, we will highlight the results of studies using Cox proportional hazards model to compare patient and technique survival between continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) for patients with diabetic nephropathy as well as for all dis ease categories.
