Peritoneal Dialysis Modality and Outcomes in the Peritoneal Dialysis Outcomes and Practice Patterns Study

Automated peritoneal dialysis (APD) is the predominant peritoneal dialysis (PD) modality in many high-income countries and is increasingly adopted in low- and middle-income settings. Outcome differences between APD and continuous ambulatory PD (CAPD) remain unclear. A clearer understanding could inform clinical and policy decisions.

Patients in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS; N = 9463 patients across 6 countries/regions) who were enrolled within 3 months of starting PD were analyzed in intent-to-treat Cox regression models examining associations between PD modality (CAPD vs. APD) and patient survival, permanent transfer to hemodialysis (HD, HDT), and time to first peritonitis, adjusting for patient and facility-level factors and stratified by country.

Of the patients, 87% were prescribed APD (range: 37% in South Korea to 91% in USA). APD patients were younger, had lower urine output, more often used hypertonic solutions, and less often used icodextrin. Overall, there was no evident difference between APD and CAPD in survival (adjusted hazard ratio [AHR]: 0.82, 95% confidence interval [CI]: 0.66-1.03) or HDT (AHR: 0.96, 95% CI: 0.83-1.11), though results varied by country and subgroups (APD had lower death risk in those having assisted PD). APD patients had a lower risk of peritonitis overall (AHR: 0.83, 95% CI: 0.72-0.97), and specifically of gram-positive (AHR: 0.67, 95% CI: 0.52-0.87) and culture-negative (AHR: 0.64, 95% CI: 0.44-0.95) peritonitis.

APD and CAPD showed comparable patient and technique survival. APD's lower peritonitis rate highlights the importance of aseptic technique; its benefits in assisted PD patients suggest that it may be suited for those requiring support.