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In Reply: Dr Goel points out that patients with peritoneal dialysis differed from those receiving hemodialysis in a variety of ways, thus raising the possibility of selection bias. We used a number of techniques to adjust for the measured differences between patients, including propensity score analysis. Nonetheless, we acknowledge that patients receiving peritoneal dialysis may differ with regard to unmeasured factors. The only way to resolve this question would be to conduct a randomized study of dialysis modality, but such studies have proved unfeasible because of very low enrollment rates.¹ Thus, we believe that carefully performed observational studies with comparison groups may yield the best evidence on patient satisfaction with dialysis modality.

We designed our study to include only incident patients, that is, new-onset patients beginning dialysis for the first time. We agree that an interesting comparison would be to study patients who switched dialysis modality from peritoneal dialysis to . . . [Full Text of this Article]

Haya R. Rubin, MD, PhD
hrubin@jhmi.edu

Neil R. Powe, MD, MPH, MBA
Department of Medicine
The Johns Hopkins School of Medicine
Baltimore, Md

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