677 www.sin-italy.org/jnonline – www.jnephrol.com © 2010 Società Italiana di Nefrologia - ISSN 1121-8428 JN ( 2010; : 06) 677-682 23 EPHROL INTRODUCTION End-stage renal disease (ESRD) has been recognized as an emerging clinical problem all over the world. In Tai- wan, the incidence rate increased from 375 per million population (PMP) in 2004 to 404 PMP in 2005, whereas the prevalence rate increased from 1,706 PMP in 2004 to 1,830 PMP in 2005 (1). Under the new policy of cost containment of the National Health Insurance of Taiwan, peritoneal dialysis (PD) has been promoted mainly due to its lower expenditure compared with hemodialysis (HD). PD may also be superior to HD in other aspects. PD pre- serves residual renal function better (2-4) and is associ- ated with higher scores for quality of life (5, 6). In terms of survival, however, the results seem inconsistent. Some studies suggested a survival advantage of PD over HD (7, 8), but others reported that HD patients lived longer than PD patients (9, 10). Similarity in survival was seen in some investigations (11, 12); yet another analysis showed that PD survival was better only at an earlier stage of the dialysis course (13). Although there was a previous study with a big sample size conducted in Taiwan (14), neither that study nor the above-mentioned ones were random- ized clinical trials. As choice of renal replacement therapy often depends on the decision of both patients and medi- cal staff, and thus involves an unavoidable selection bias, more outcome studies with longer follow-up periods are needed to draw any conclusion. Prevention over treatment is not generally practiced. For example, despite the evidence of health benefit from early referral of chronic kidney disease patients to neph- rologist care (15), such practice is limited. As the lifelong costs of renal replacement therapy for ESRD patients are ABSTRACT Background: Expected years of life lost (EYLL) in dialy- sis patients are rarely discussed. This study compared life expectancy, EYLL and survival between hemodi- alysis (HD) and peritoneal dialysis (PD) patients. Methods: Adults who underwent maintenance dialysis at National Taiwan University Hospital from 1995 to 2006 were followed up until December 2007. Kaplan-Meier analysis and a constant excess hazard model were used to estimate and project long-term survival. EYLL was calculated by subtracting the life expectancy of patients from that of age- and sex-matched referents. HD pa- tients were then matched with PD patients on age, sex and diabetes mellitus (DM). Life expectancy, EYLL and survival between the 2 groups were compared. Mortality risks were determined by the Cox model. Results: Before matching, the 305 HD patients were older than the 428 PD patients (62.4 ± 13.7 vs. 53.1 ± 16.7 years; p<0.0001). More HD patients had DM (HD vs. PD, 29.2% vs. 20.6%; p=0.0072). Life expectancy and EYLL of HD patients were 8.8 and 11.5 years, compared with those of PD patients (19.9 and 7.4 years). After matching, life expectancy (p=0.790) and EYLL (p=0.793) of both groups (236 patients each) were similar. Age (adjusted hazard ratio [AHR] = 1.07; 95% confidence in- terval [95% CI], 1.05-1.09) and DM (AHR=3.81; 95% CI, 2.28-6.36) were independent mortality predictors. For diabetic patients who underwent HD, a better survival rate was observed (AHR=0.24; 95% CI, 0.11-0.53). Conclusions: After matching, HD and PD patients had similar life expectancy and EYLL. Survival was better for diabetic patients if they received HD. Key words: Hemodialysis, Life expectancy, Peritoneal dialysis, Survival 1 Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei - Taiwan 2 Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei - Taiwan 3 Department of Environmental and Occupational Medicine, National Taiwan University Hospital, Taipei - Taiwan Tze-Wah Kao 1, 2 , Jenq-Wen Huang 1 , Kuan-Yu Hung 1 , Yu-Yin Chang 2 , Pau-Chung Chen 2, 3 , Chung-Jen Yen 1 , Yung-Ming Chen 1 , Tzong-Shinn Chu 1 , Ming-Shiou Wu 1 , Tun-Jun Tsai 1 , Kwan-Dun Wu 1 , Jung-Der Wang 1, 2, 3 Life expectancy, expected years of life lost and survival of hemodialysis and peritoneal dialysis patients ORIGINAL ARTICLE