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Vascular disease: the critical risk factor for mortality in older patients on CAPD
A H Tzamaloukas1, P G Zager, A M Harford
1Renal Section, Albuquerque V.A. Medical Center.
Insights
Older patients on continuous ambulatory peritoneal dialysis (CAPD) with vascular disease face higher risks. Vascular disease significantly limits survival in this population, impacting outcomes more than dialysis-related complications.
Area of Science:
- Nephrology
- Geriatrics
- Vascular Medicine
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment option for end-stage renal disease.
- Older adults initiating CAPD present unique challenges due to comorbidities.
Purpose of the Study:
- To analyze the clinical course, complications, and outcomes of elderly patients (≥55 years) undergoing CAPD.
- To compare outcomes between elderly CAPD patients with high vascular disease risk versus those with lower risk.
Main Methods:
- Retrospective analysis of 75 elderly CAPD patients (age 55-81).
- Patients stratified into three groups based on vascular disease risk: Group A (high risk, N=45), Group B (lower risk, N=22), and Group C (miscellaneous, N=8).
- Comparison focused on patient survival, technique survival, complication rates, and vascular events between Group A and Group B.
Main Results:
- Patient and technique survival were statistically higher in Group B (lower vascular risk) compared to Group A (high vascular risk).
- Peritoneal dialysis-related complications were comparable between groups A and B; hernias were frequent and led to CAPD discontinuation.
- Catastrophic vascular events, especially in the limbs, were significantly more frequent in Group A. Vascular disease was the primary cause of death across all groups.
Conclusions:
- Vascular disease is the principal determinant of survival in older patients undergoing CAPD.
- CAPD offers survival benefits over hemodialysis for a select group of elderly patients with severe cardiovascular instability.
Abstract:
Clinical course, complications and outcome were analyzed in 75 patients (14 women, 61 men) who started CAPD at age 55 years or older (55-81). These patients were separated in three groups. Group A patients had high risk for vascular disease (diabetes, hypertension, N = 45), group B patients had a presumed lower risk for vascular disease (primary renal disease, N = 22), and group C patients had miscellaneous conditions (N = 8). Group A was compared to group B. Patient and technique survival was statistically higher for group B than for group A. The rates of peritoneal dialysis related complications (peritonitis, tissue infections, catheter loss, hernias) were comparable between groups A and B. Hernias were seen frequently in all groups and had severe sequellae, including discontinuation of CAPD. Catastrophic vascular events were also seen in all groups, but the frequency of such events, particularly of catastrophic vascular events of the limbs, was statistically higher in group A than in group B. Vascular disease accounted for the majority of deaths in all groups. Four patients died from cardiovascular instability soon after changing from CAPD to hemodialysis. In conclusion, vascular disease is the major factor limiting survival in older CAPD patients. CAPD is superior to hemodialysis for a relatively small fraction of older patients with severe cardiovascular instability.