HD patients switched modality at least once compared to 46% of PD patients.31 A Canadian study reported technique survival for PD and HD was similar up to 10 months followup.39 After 10 months and through 60 months of follow-up, technique survival was lower for the PD group. Another Canadian study found greater risk of technique failure with PD compared to HD (186/1000 person-years vs 165/1000 person-years; RR 1.15 [95% CI 1.01, 1.31]).41 In 2 European studies, 25% (over 3 years)44 and 11% (over 7 years)46 of PD patients switched modalities compared to 4%44 and 1%46 of HD patients. One study reported median time at the modality switch was 12 months for PD and 4 months for HD.46 A third European study reported that 0.6% of HD patients and 0.9% of PD patients changed dialysis modality during the followup period of up to 5 years.48 The modality change occurred at a median of 11 months for the HD to PD patients and at a median of 13 months for the PD to HD patients. In the CHOICE cohort study, 25% of the patients who were initially on PD switched modality at least once over maximum follow-up of 7 years compared to 5% of those who were initially on HD.51 From the NECOSAD cohort, 2 year technique survival was 96% for HD patients and 74% for PD patients.53 Transplantation (Appendix C, Table 1) Transplantation was reported in 6 registry studies. One USRDS study reported that transplant rates during the first 2 years of dialysis were 6% for HD and 18% for PD.26 Another USRDS study reported the hazard ratio for renal transplant over up to 6 years follow-up (PD vs HD) was 1.48 (95% CI 1.29, 1.70).27 A study from Canada also reported higher transplantation over a maximum of 5 years follow-up in PD compared to HD (RR 1.16, 95% CI 1.06, 1.28).41 Two European studies found comparable percentages of transplants between PD and HD; 17.9% (PD) and 17.7% (HD) in a multinational study with maximum follow-up of 3 years44 and 2.3% (PD) and 3.5% (HD) in a study from France with maximum follow-up of 7 years.46 The mean time to transplant after start of RRT was 25 months for the PD patients and 22 months for the HD patients.46 Another European study, with maximum follow-up of 5 years, reported lower transplantation in the PD group (0.4%, median time 9.5 months) than in the HD group (2.1%, median time 11 months).48 In the NECOSAD cohort, 15% of the original HD cohort and 21% of the original PD cohort underwent renal transplant during a follow-up period of up to 4 years.53 36 Home-based versus In-center Dialysis Evidence-based Synthesis Program Table 3. US Studies Included in Systematic Review (Boateng 2011) Author, Year Modalities Inclusion Criteria Patient Characteristics Quality of Life Other Outcomes Kutner 200060 PD, HD Risk of Bias: High Selection bias: inadequate Blinding: inadequate ITT: unclear Attrition bias: inadequate Selective outcome reporting: no Age ≥20, started on HD or PD July 1996-August 1997, not cognitively impaired, able to communicate in English or Spanish N=226 (154 HD, 72 PD) Age (yr): 56* Gender (% male): 53 Race (%): white 46, black 48 *PD patients were younger and less likely black -Baseline SF-36 (mean of 67.3 days on dialysis): no significant differences between HD and PD patients for any of the 8 dimensions -KDQOL: being on PD was associated with higher “staff encouragement” (the extent to which the dialysis staff encourages the patient to be independent and supports the patient in coping with kidney disease) and “satisfaction with care” received for dialysis PD patient (vs HD) associated with ability to complete a greater number of chair rise cycles (sitto-stand-tosit) Diaz-Buxo 200061 PD, HD Risk of Bias: High Selection bias: inadequate Blinding: unclear ITT: unclear Attrition bias: unclear Selective outcome reporting: no Fresenius Medical Care North America patient, completed SF-36 in 1996 N=18,015 (16,755 HD, 1,260 PD) Age (yr): 59* Gender (% male): 52 Race (%): white 54 *PD patients younger and more likely white -SF-36 PCS: no difference between HD (33.3±10.4) and PD (33.7±10.6); no difference when adjusted for case mix or for case mix plus laboratory variables -Physical function dimensions: HD scores lower than PD for physical function (unadjusted) and bodily pain (unadjusted and adjusted); HD scores higher for general health (unadjusted) -SF-36 MCS: no difference between HD (47.5±11.7) and PD (47.9±11.6); better scores for PD after adjustment for case mix (P = .015) and case mix plus laboratory variables (P = .014) -Mental function dimensions: HD scores higher than PD scores for vitality (unadjusted and adjusted); HD scores lower than PD scores for role-emotional and mental health (unadjusted and adjusted) and social functioning (adjusted) NR Wu 200462 (CHOICE) PD, HD Risk of Bias: High Selection bias: inadequate Blinding: N/A ITT: yes Attrition bias: inadequate Selective outcome reporting: no Age ≥18, able to speak English or Spanish, excluded HHD patients; oversampled PD patients N=928 incident patients (698 HD, 230 PD) who completed baseline CHEQ (89% of total study sample) Age (yr): 58* Gender (% male): 53 Race (%): white (68), black (28), other (5)* *PD patients younger and more likely white -585 completed CHEQ at 1 year -Adjusted mean change over 1 year: a. HD patients showed greater