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Comparison of survival in CAPD and hemodialysis: a multicenter study
A Lupo1, G Cancarini, L Catizone
1Divisione Nefrologia, Ospedale Civile Maggiore, Verona, Italy.
Insights
This study compared continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) for 1,622 patients. Patient survival at six years showed no significant difference between CAPD and HD, with potential benefits for older patients on CAPD.
Area of Science:
- Nephrology
- Clinical Medicine
- Renal Replacement Therapy
Background:
- Dialysis is a critical treatment for end-stage renal disease.
- Continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) are common modalities.
- Patient selection and outcomes can vary between dialysis types.
Purpose of the Study:
- To compare patient survival rates between CAPD and HD.
- To evaluate the impact of patient characteristics on survival in different dialysis modalities.
- To assess the long-term efficacy of CAPD versus HD in a large patient cohort.
Main Methods:
- A multicenter study involving 1,622 patients initiating dialysis between 1985-1989.
- Categorization of patients into CAPD (41%) and HD (59%) groups.
- Application of multivariate analysis (Cox's model) to assess survival predictors.
Main Results:
- Overall six-year patient survival was comparable between CAPD (42%) and HD (54%).
- Age and pretreatment risk factors significantly impacted survival across all patients (p < 0.0001).
- Dialysis modality (CAPD vs. HD) was not a significant predictor of survival in multivariate analysis.
Conclusions:
- Patient survival at six years is not statistically different between CAPD and HD.
- Age significantly influences survival, with a less pronounced effect in the CAPD group.
- CAPD may offer survival advantages for older patients, despite initial selection criteria.
Abstract:
We studied 1,622 patients who started regular dialysis treatment between 1985 and 1989 in 19 centers from the Italian CAPD Study Group. There were 962 pts (59%) and on HD; 660 pts (41%) on CAPD. CAPD pts were older and had more risk factors at the start than HD pts (p < 0.0001). Overall patient survival was not statistically different between CAPD and HD at 6 years (42% CAPD; 54% HD). Multivariate analysis (Cox's model) on all population revealed that age and pretreatment risk factors had a statistically significant impact on patient survival (p < 0.0001), but not the type of dialytic treatment (CAPD or HD). When multivariate analysis was applied separately by treatment modalities, in HD group age and risk factors had the same negative influence on survival (p < 0.0001) while in CAPD group the influence of age on survival was less significant (p 0.025). This multicenter study carried out with appropriate statistical methods in a large number of pts demonstrates that patients' survival at 6 years is not different on CAPD and HD (despite the worse patient selection on CAPD) and can be even better on CAPD for aged patients.