Dialysis Modality may be selected according to comorbid conditions in Elderly ESRD Patients, suggests study
A new study published in the journal of BMC Nephrology showed that dialysis selection for older individuals with end-stage renal disease (ESRD) should be tailored to their specific comorbidities.
Elderly patients with ESRD have additional ethical and clinical difficulties, especially when selecting the best dialysis technique. The physiological demands, functional status impact, complication profiles, and quality of life consequences of hemodialysis (HD) and peritoneal dialysis (PD) are significantly different.
Multimorbidity, fragility, and a lack of social support are frequently linked to advanced age, all of which have an impact on treatment tolerance and results. In order to guide the choice of dialysis modality, this study compared the survival differences between HD and PD in older patients (≥60 years old) with ESRD and examined the effects of important comorbidities on prognosis and causes of death.
377 senior ESRD patients (216 HD, 161 PD) who started dialysis between 2012 and 2017 were included in this single-center retrospective cohort research, which followed them until 2024. Using the Kaplan-Meier technique, survival rates were compared. The patients with diabetes, heart failure, and cerebrovascular disease underwent subgroup analyses.
The HD group was much less likely than the PD group to die from all causes in the general population (adjusted HR = 0.599, 95% CI: 0.45–0.79). The survival benefit of HD was especially noticeable in patients with concurrent heart failure (adjusted HR = 0.422, 95% CI: 0.25–0.70) or diabetes (adjusted HR = 0.687, 95% CI: 0.48–0.98), according to subgroup analyses.
HD was shown to be an independent risk factor for hemorrhagic mortality (sHR = 8.773, 95% CI: 1.03–74.42), and the cumulative frequency of these events was much lower in the PD group. Overall, comorbidities should be taken into consideration while choosing a dialysis method for senior ESRD patients. HD may be given priority for people with concurrent diabetes or heart failure since it may be linked to a survival benefit. For individuals with cerebrovascular illness who are at high risk of bleeding, PD could be a safer choice.
Source:
Yu, R., Yan, Y., Lin, J., Li, H., Cai, Y., Wang, L., Liu, X., & He, Z. (2026). Hemodialysis versus peritoneal dialysis in elderly ESRD patients: a retrospective cohort study on survival and the role of comorbidities. BMC Nephrology. https://doi.org/10.1186/s12882-026-04783-7
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