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

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Dialysis Modalities

Background:

• Automated peritoneal dialysis (APD) is a prevalent dialysis method globally.
• Clinical outcomes between APD and continuous ambulatory peritoneal dialysis (CAPD) require further clarification to guide practice.

Purpose of the Study:

• To compare patient survival, hemodialysis transfer, and peritonitis rates between APD and CAPD.
• To analyze outcomes across different countries and patient subgroups.

Main Methods:

• Analysis of 9463 patients from the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS).
• Intent-to-treat Cox regression models were used to assess associations between PD modality and outcomes.
• Adjustments were made for patient and facility factors, with stratification by country.

Main Results:

• No significant difference in patient survival or transfer to hemodialysis between APD and CAPD.
• APD was associated with a lower overall risk of peritonitis (AHR: 0.83) and specifically gram-positive (AHR: 0.67) and culture-negative (AHR: 0.64) peritonitis.
• APD showed a lower death risk in assisted PD patients.

Conclusions:

• APD and CAPD offer comparable patient and technique survival.
• APD's reduced peritonitis risk underscores the importance of aseptic technique.
• APD may be particularly beneficial for patients requiring assistance during dialysis.