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CAPD versus hemodialysis (HD): 7 years of experience
P L Cavalli1, G Viglino, F Goia
1Servizio Nefrologia e Dialisi, Osp. S. Lazzaro, Alba.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) and standard hemodialysis (HD) showed similar patient survival and dropout rates. However, CAPD patients experienced fewer peritonitis episodes after implementing enhanced monitoring.
Area of Science:
- Nephrology
- Internal Medicine
- Renal Replacement Therapy
Background:
- Chronic kidney disease necessitates renal replacement therapy.
- Both continuous ambulatory peritoneal dialysis (CAPD) and standard hemodialysis (HD) are established treatment options.
- Comparing outcomes of initial CAPD versus HD is crucial for patient management.
Purpose of the Study:
- To compare patient survival and dropout rates between CAPD and standard HD as initial renal replacement therapy.
- To identify the primary reasons for treatment discontinuation in both groups.
- To evaluate the impact of enhanced patient monitoring on CAPD outcomes.
Main Methods:
- A cohort study comparing 42 patients on CAPD with 48 patients on standard HD from November 1981 to December 1988.
- Analysis of survival, dropout rates, and causes for discontinuation.
- Life table analysis to assess differences in death and dropout incidence.
- Subgroup analysis of CAPD patients based on the introduction of enhanced clinical/social surveys and home visits in late 1985.
Main Results:
- No significant differences in mean age or risk factors between CAPD and HD groups.
- At study end, 50.0% of CAPD patients and 37.5% of HD patients remained on their initial treatment.
- Clinical problems were the most common reason for dropout in both groups.
- Life table analysis revealed no significant differences in death or dropout rates between CAPD and HD.
- CAPD patients starting treatment after 1985 showed a significant decrease in peritonitis episodes.
Conclusions:
- CAPD and standard HD demonstrate comparable long-term survival and dropout rates when initiated as first-line treatment.
- Enhanced patient monitoring and support protocols in CAPD can significantly reduce complication rates, such as peritonitis.
- Treatment choice between CAPD and HD should consider individual patient factors and the availability of robust support systems.
Abstract:
The purpose of this work is to compare survival and drop-out in 2 groups of patients undergoing either CAPD (42 pts) or standard HD (48 pts) as first treatment, from November 1981 to December 1988. Mean age and number of risk factors were not significantly different. At the end of the study 50.0% of pts on CAPD and 37.5% on HD were still on first treatment; clinical problems were the most frequent cause of drop-out. The total period of observation was significantly higher in the CAPD group (1391.0 months vs 850.4), but the life table analysis showed no significant differences in the incidence of death and of drop-out in the two groups. The follow-up of the CAPD group was subdivided into two periods, due to the fact that a scheme for clinical and social survey of patients undergoing dialysis and a policy of more frequent home visits were introduced at the end of 1985. A significant decrease of peritonitis episodes was observed in the second period.