Peritonitis-free survival in peritoneal dialysis: an update taking competing risks into account
Identifieur interne : 000961 ( Main/Exploration ); précédent : 000960; suivant : 000962Peritonitis-free survival in peritoneal dialysis: an update taking competing risks into account
Auteurs : David W. Evans [France] ; Jean-Philippe Ryckelynck [France] ; Emmanuel Fabre [France] ; Christian Verger [France]Source :
- Nephrology Dialysis Transplantation [ 0931-0509 ] ; 2010-07.
Abstract
Background. Peritonitis-free survival is commonly reported in the peritoneal dialysis (PD) literature. The KaplanMeier method appears to be the only technique used to date, although it has known limitations for cohorts with multiple outcomes, as in PD. In the presence of these competing risks outcomes, the KaplanMeier estimate is interpretable only under restrictive assumptions. In contrast, methods which take competing risks into account provide unbiased estimates of probabilities of outcomes as actually experienced by patients. Methods. We analysed peritonitis-free survival in a cohort of 8711 incident patients from the Registre de Dialyse Pritonale de Langue Franaise between 1 January 2000 and 31 December 2007 by calculating the cumulative incidence (CI) of the first episode of peritonitis using the KaplanMeier method and a method accounting for competing risks. We compared the CI in different patient groups by the log-rank test and a test developed for competing risk data, Grays test. Results. After 5 years of PD, the CI of at least one peritonitis episode was 0.4, and the probability of any outcome was 0.96. The KaplanMeier method overestimated the CI by a large amount. Compared with the log-rank test, Grays test led to different conclusions in three out of seven comparisons. Conclusions. The competing risk approach shows that the CI of at least one peritonitis episode was lower than reported by the KaplanMeier method but that survival peritonitis-free and still on PD was overall low. The competing risk approach provides estimates which have a clearer interpretation than KaplanMeier methods and could be more widely used in PD research.
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DOI: 10.1093/ndt/gfq003
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Evans</name></author><author><name sortKey="Ryckelynck, Jean Philippe" sort="Ryckelynck, Jean Philippe" uniqKey="Ryckelynck J" first="Jean-Philippe" last="Ryckelynck">Jean-Philippe Ryckelynck</name></author><author><name sortKey="Fabre, Emmanuel" sort="Fabre, Emmanuel" uniqKey="Fabre E" first="Emmanuel" last="Fabre">Emmanuel Fabre</name></author><author><name sortKey="Verger, Christian" sort="Verger, Christian" uniqKey="Verger C" first="Christian" last="Verger">Christian Verger</name></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:1C98DC496464BF3595C03CE7610593EA46036878</idno><date when="2010" year="2010">2010</date><idno type="doi">10.1093/ndt/gfq003</idno><idno type="url">https://api.istex.fr/document/1C98DC496464BF3595C03CE7610593EA46036878/fulltext/pdf</idno><idno type="wicri:Area/Istex/Corpus">001775</idno><idno type="wicri:Area/Istex/Curation">001775</idno><idno type="wicri:Area/Istex/Checkpoint">000145</idno><idno type="wicri:doubleKey">0931-0509:2010:Evans D:peritonitis:free:survival</idno><idno type="wicri:Area/Main/Merge">000962</idno><idno type="wicri:Area/Main/Curation">000961</idno><idno type="wicri:Area/Main/Exploration">000961</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a">Peritonitis-free survival in peritoneal dialysis: an update taking competing risks into account</title><author><name sortKey="Evans, David W" sort="Evans, David W" uniqKey="Evans D" first="David W." last="Evans">David W. 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Peritonitis-free survival is commonly reported in the peritoneal dialysis (PD) literature. The KaplanMeier method appears to be the only technique used to date, although it has known limitations for cohorts with multiple outcomes, as in PD. In the presence of these competing risks outcomes, the KaplanMeier estimate is interpretable only under restrictive assumptions. In contrast, methods which take competing risks into account provide unbiased estimates of probabilities of outcomes as actually experienced by patients. Methods. We analysed peritonitis-free survival in a cohort of 8711 incident patients from the Registre de Dialyse Pritonale de Langue Franaise between 1 January 2000 and 31 December 2007 by calculating the cumulative incidence (CI) of the first episode of peritonitis using the KaplanMeier method and a method accounting for competing risks. We compared the CI in different patient groups by the log-rank test and a test developed for competing risk data, Grays test. Results. After 5 years of PD, the CI of at least one peritonitis episode was 0.4, and the probability of any outcome was 0.96. The KaplanMeier method overestimated the CI by a large amount. Compared with the log-rank test, Grays test led to different conclusions in three out of seven comparisons. Conclusions. The competing risk approach shows that the CI of at least one peritonitis episode was lower than reported by the KaplanMeier method but that survival peritonitis-free and still on PD was overall low. The competing risk approach provides estimates which have a clearer interpretation than KaplanMeier methods and could be more widely used in PD research.</div></front></TEI><affiliations><list><country><li>France</li></country><settlement><li>Caen</li><li>Paris</li><li>Pontoise</li></settlement></list><tree><country name="France"><noRegion><name sortKey="Evans, David W" sort="Evans, David W" uniqKey="Evans D" first="David W." last="Evans">David W. Evans</name></noRegion><name sortKey="Evans, David W" sort="Evans, David W" uniqKey="Evans D" first="David W." last="Evans">David W. Evans</name><name sortKey="Evans, David W" sort="Evans, David W" uniqKey="Evans D" first="David W." last="Evans">David W. Evans</name><name sortKey="Fabre, Emmanuel" sort="Fabre, Emmanuel" uniqKey="Fabre E" first="Emmanuel" last="Fabre">Emmanuel Fabre</name><name sortKey="Ryckelynck, Jean Philippe" sort="Ryckelynck, Jean Philippe" uniqKey="Ryckelynck J" first="Jean-Philippe" last="Ryckelynck">Jean-Philippe Ryckelynck</name><name sortKey="Verger, Christian" sort="Verger, Christian" uniqKey="Verger C" first="Christian" last="Verger">Christian Verger</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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