Objective To assess the cost-utility study of renal transplantation compared with nemodialysis (HD) and peritoneal dialysis (PD). Methods A prospective study of end-stage renal disease patients was followed up for 3 months after renal replacement therapy. The study population included 196 patients (renal transplant [RT] n=63, hemodialysis [HD] n=82 and continious ambulatory peritoneal dialysis [CAPD] n=51) from 6 hospitals of Sichuan province. Health-related quality of life was assessed by using the WHOQOL-BRIEF questionnaire. Utility scores were obtained so as to conduct CUA (cost-utility analysis). Costs were collected from financial department and by patient interview. Results The utility values were 0.539 9± 0.013 for RT, 0.450 8± 0.014 for HD, 0.512 2±0.099 for CAPD, respectively. The mean direct cost of the first three months of renal transplant was significantly higher than dialysis (RT and CAPD). Over 3 months, the average cost per quality-adjusted life year (QALY) for patients after CAPD was lower than HD and RT. Compared to HD, incremental cost analysis showed that CAPD was more ecnomical than RT. Sensitive analysis showed that CAPD was more effective than RT when ΔQALY varied in the limit of 95% confidence interval. However, the cost-utility of RT vs HD and CAPD vs HD was varied with ΔQALY level. Conclusions Cost-utility analysis showed that CAPD was a more favorable cost-utility ratio when compared to RT at early stage RT vs HD and CAPD vs HD, but which cost-utility ratio is better, we can not draw a certain conclusion.
Objective To evaluate the effects of glucose-containing dialysate versus glucose-free dialysate on blood pressure variability and blood glucose variability in maintenance hemodialysis (MHD) patients and to assess safety. Methods MHD patients from 12 hospitals were enrolled between October 2024 and June 2025. According to the randomized block design, patients were randomly divided into the glucose-containing dialysate group (experimental group) and the glucose-free dialysate group (control group). During hemodialysis sessions, blood pressure were monitored at 0, 1, 2, 3, and 4 hours, and blood glucose was measured at 0, 2, and 4 hours monthly for six consecutive months. Hypotension episodes and hypoglycemic episodes were recorded throughout dialysis. Results A total of 244 MHD patients were included, with 122 in each group. Compared with the control group, the experimental group showed significantly lower systolic blood pressure variability [dialysis for 2 hours: 9.92 (7.92, 12.52) vs. 11.95 (9.45, 15.36) mm Hg (1 mm Hg=0.133 kPa), P<0.001; during the 0-2 hour dialysis period: 2.60 (1.24, 3.97) vs. 3.74 (2.03, 6.52) mm Hg, P=0.011], diastolic blood pressure variability [during the 0-4 hour dialysis period: 3.85 (1.49, 6.69) vs. 4.72 (1.99, 8.46) mm Hg, P<0.001], blood glucose variability [dialysis for 2 hours: 0.16 (0.12, 0.20) vs. 0.18 (0.13, 0.23) mmol/L, P=0.002; dialysis for 4 hours: 0.17 (0.13, 0.22) vs. 0.21 (0.17, 0.26) mmol/L, P<0.001; during the 2-4 hour dialysis period: 0.04 (0.02, 0.08) vs. 0.07 (0.03, 0.10) mmol/L, P=0.004], incidence rates of hypotension (32.9% vs. 33.3%, P=0.005) and incidence rates of hypoglycemia (0.42% vs. 4.02%, P<0.001). Conclusions Glucose-containing dialysate reduces both blood pressure variability and blood glucose variability more effectively than glucose-free dialysate during hemodialysis. Compared with glucose-free dialysate, the glucose-containing dialysate demonstrated a lower incidence of hypotension episodes and hypoglycemic episodes.