Abstract: Objective  To compare the risk of severe bleeding events in hemodialysis (HD) patients and peritoneal dialysis (PD) patients.  Methods  A total of 1,745 patients with end-stage renal disease (ESRD) who started dialysis treatment in Pinghu Hospital of Traditional Chinese Medicine from June 2013 to July 2018 were prospectively recruited. Patients were divided into HD group (n=1,211, 69.4%) and PD group (n=534, 30.6%) according to the dialysis method. They were followed up for 3 years. Demographic and clinical data were collected. Bleeding event was defined as the bleeding leading to hospitalization or death within the follow-up period of 3 years. Kaplan-Meier curve and log-rank test were used to compare the incidence of bleeding event between the two groups within the follow-up period of 3 years. Cox regression analysis with time-dependent independent variables was used to calculate the risk ratio (HR) and 95% confidence interval (95% CI) of bleeding events in HD and PD groups after adjusting for covariates.  Results  During the 3 years of follow-up, 183 patients had a first bleeding event within a median of 2.2 years (P25: 1.0, P75: 3.0). Of these bleeding patients, 144 received HD and 39 received PD in the baseline period. The cumulative incidence of bleeding event was 15.5% in HD group and 9.7% in PD group (log rank test: χ2=5.872, P=0.013). Cox regression analysis with time-dependent independent variables and after adjusting for confounding factors showed that the adjusted HR for bleeding risk in HD patients was 1.6 (95% CI: 1.2~2.5, P=0.014) as compared with PD patients; the adjusted HR of bleeding risk in HD patients taking antithrombotic drugs was 2.0 (95% CI: 1.3~3.8, P=0.002) as compared with the PD patients without antithrombotic drug treatment; the adjusted HR of bleeding risk in HD patients with cardiovascular complications was 1.9 (95% CI: 1.3~3.1, P=0.022) as compared with the PD patients without cardiovascular complications; the adjusted HR of bleeding risk in HD patients with previous bleeding history was 3.2 (95% CI: 2.0~5.8, P＜0.001) as compared with the PD patients without previous bleeding history.  Conclusions   The risk of bleeding event in HD patients was 1.6 times higher than that in PD patients. HD patients who received antithrombotic therapy, had cardiovascular disease, and had a history of bleeding were at a higher risk of severe bleeding.

Key words: End stage renal disease, Hemodialysis, Peritoneal dialysis, Bleeding event