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[CAPD versus hemodialysis. 7 years' experience at the Centro Dialisi in Alba]
P L Cavalli1, F Goia, G Viglino
1U.S.S.L. n. 65, Ospedale Civile "S. Lazzaro", Alba, Servizio di Nefrologia e Dialisi.
Insights
Continuous Ambulatory Peritoneal Dialysis (CAPD) and standard hemodialysis (HD) showed similar patient survival and method change rates. CAPD maintained more patients on initial treatment, indicating its value for end-stage renal failure.
Area of Science:
- Nephrology
- Renal Replacement Therapy
Background:
- End-stage renal failure (ESRF) necessitates renal replacement therapy.
- Continuous Ambulatory Peritoneal Dialysis (CAPD) and standard hemodialysis (HD) are primary treatment options.
Purpose of the Study:
- To compare patient survival and method change drop-out rates between CAPD and HD as initial ESRF treatments.
- To evaluate the medium-term efficacy and patient retention of CAPD versus HD.
Main Methods:
- Prospective study comparing 41 CAPD patients with 45 HD patients from November 1981 to August 1988.
- Life table analysis used to assess outcomes including death and drop-out for method change.
- Patient demographics, age, and risk factors were analyzed for significant differences.
Main Results:
- No significant differences in death rates (10 vs 13) or drop-out for method change (8 vs 10) between CAPD and HD groups.
- Significantly more patients remained on their initial treatment in the CAPD group (51.2%) compared to HD (33.3%).
- Clinical problems were the primary reason for drop-out in both groups (62.5% CAPD, 70.0% HD).
Conclusions:
- CAPD is a viable medium-term treatment for end-stage renal failure, comparable to standard HD.
- Patient selection is crucial for optimizing CAPD outcomes.
- CAPD demonstrates good patient retention when not negatively selected.
Abstract:
The purpose of the study is to compare the survival of the patients and the drop-out for change of the method in 2 groups of patients (pts) undergoing either CAPD (41 pts) or standard hemodialysis (HD) (45 pts) as first treatment, since November 1981 to August 1988. Distribution per sex (24 males and 17 females in the CAPD group vs 32 males and 13 females in the HD group), mean age (61.3 years vs 56.7) and number of risk factors (57 vs 61) were not significantly different. The total period of observation was significantly higher (1305.8 months vs 780.3, P less than 0.01) and the results seemed to be better in the CAPD group, but the life table analysis showed no significant differences in the incidence of death (10 events vs 13) and of drop-out for change of the method (8 events vs 10) respectively in the CAPD and in the HD group. At the end of the study 51.2% of pts on CAPD and 33.3% on HD were still on first treatment; clinical problems (respectively 62.5% and 70.0%) were the most frequent cause of drop-out. The Authors conclude that CAPD in the medium-term is a valuable method of treatment of end-stage renal failure, competitive with standard HD when patient selection is not biased by a negative selection.