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A multicenter, selection-adjusted comparison of patient and technique survivals on CAPD and hemodialysis
R Maiorca1, E F Vonesh, P Cavalli
1Division of Nephrology, University and Civic Hospital, Brescia, Italy.
Insights
Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) show similar patient survival rates over seven years. However, CAPD demonstrates better technique survival, especially when peritonitis is excluded, making it a viable alternative to HD.
Area of Science:
- Nephrology
- Internal Medicine
- Clinical Epidemiology
Background:
- Dialysis is a critical treatment for end-stage renal disease.
- Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) are common renal replacement therapies.
- Patient characteristics and outcomes differ between dialysis modalities.
Purpose of the Study:
- To compare patient and technique survival between CAPD and HD.
- To identify factors influencing survival in dialysis patients.
- To evaluate CAPD as an alternative to HD.
Main Methods:
- A 7-year observational study of 480 CAPD and 373 HD patients across 6 centers.
- Utilized Cox's proportional hazards regression to analyze survival data.
- Adjusted for patient age and comorbidities including cardiovascular, cerebrovascular, peripheral vascular diseases, diabetes, malignancy, and multisystem disease.
Main Results:
- No significant difference in 7-year patient survival between CAPD and HD after adjusting for covariates.
- Higher risk of death observed in HD patients compared to CAPD patients over 53.5 years of age.
- Technique survival was center-dependent and generally better for HD than CAPD.
- No significant difference in technique survival when peritonitis was excluded as a cause of failure.
Conclusions:
- CAPD and HD offer comparable patient survival rates in the long term.
- CAPD presents a viable alternative to HD, particularly when considering technique survival without peritonitis.
- Age and specific comorbidities significantly impact patient survival on dialysis.
Abstract:
Four hundred and eighty CAPD and 373 HD patients started regular dialysis treatment between 1981 and 1987 in 6 dialysis centers. The CAPD patients were 6 years older, on average, than the HD patients and had more complicating conditions (43.3% with 3 or more coexisting risk factors versus 28.9% with coexisting complications). The 7-year patient survival rate was not significantly different. Cox's proportional hazards regression showed that age, cardiovascular disease, cerebrovascular disease, peripheral vascular disease, diabetes, malignancy and multisystem disease had significant adverse effects on patient survival. After correcting for the influence of these factors, no significant differences in patient survival were seen. However, after 53.5 years of age, the increase in the risk of death was significantly higher in HD than in CAPD patients. Technique survival was significantly different in the 6 centers and was better for HD than for CAPD. There was no statistically significant difference between CAPD and HD technique survival when peritonitis was eliminated as a cause of failure. Based on this 7 year analysis, CAPD would appear to be an excellent alternative to HD.