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Comparison of peritoneal catheter survival with fistula survival in hemodialysis
1Department of Internal Medicine, Kangnam St. Mary's Hospital, Seoul, Korea.
Insights
Continuous ambulatory peritoneal dialysis (CAPD) offers superior long-term access survival compared to hemodialysis (HD), particularly for elderly or diabetic patients. Effective peritonitis management is key to enhancing peritoneal catheter longevity.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Dialysis Access
Background:
- Maintaining reliable vascular or peritoneal access is crucial for long-term dialysis therapy.
- Continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) represent two primary modalities for end-stage renal disease management.
- The durability and maintenance of access devices significantly impact patient outcomes and treatment effectiveness.
Purpose of the Study:
- To compare the long-term access maintenance between continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD).
- To evaluate the survival rates of peritoneal dialysis catheters versus arteriovenous fistulas (AVF).
- To identify factors influencing the survival of dialysis access in different patient populations.
Main Methods:
- A retrospective study was conducted over a four- to six-year period at a single center.
- Data from 122 CAPD patients and 172 HD patients were analyzed.
- The primary outcome measure was the cumulative survival rate of peritoneal catheters and AVFs, with assessment of variables like sex, age, diabetes, and AVF type.
Main Results:
- Peritoneal catheters demonstrated significantly longer cumulative survival rates than AVFs at one, two, and three years (e.g., 63% vs. 48% at three years).
- Peritoneal catheter survival was notably better in male, elderly, and diabetic patients compared to AVF survival.
- Infectious complications (75%), particularly peritonitis, were the leading cause of peritoneal catheter failure, while prosthetic graft and advanced age were risk factors for AVF failure.
Conclusions:
- Continuous ambulatory peritoneal dialysis (CAPD) provides superior long-term access maintenance compared to hemodialysis (HD).
- CAPD access offers particular advantages for elderly and diabetic patients.
- Effective prevention and management of peritonitis are essential for prolonging peritoneal catheter survival and optimizing CAPD outcomes.
Objective:
To compare continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) with regard to long-term maintenance of access.
Design:
Retrospective study of a four- to six-year time period at one center.
Patients:
One hundred and twenty-two CAPD patients between December 1988 and December 1992, and 172 HD patients between May 1986 and December 1992.
Main Outcome Measure:
Cumulative survival rate of peritoneal catheters and arteriovenous fistulas (AVF) was the main outcome measure. Variables affecting the survival rate including sex, age, presence or absence of diabetes, and type of AVF (autogenous or prosthetic graft) were assessed. The causes of peritoneal catheter failures were analyzed.
Results:
The cumulative survival rate of all peritoneal catheters was significantly longer than the AVF survival rate (84% vs 74% at one year; 73% vs 61% at two years; and 63% vs 48% at three years) (p = 0.029). There were no differences in peritoneal catheter survival according to sex, age, or diabetes. Compared with AVF survival, peritoneal catheter survival was significantly longer in male (p = 0.0492), elderly (p = 0.0082), and diabetic (p = 0.0022) patients. Prosthetic graft and old age were risk factors for AVF survival. Of all peritoneal catheter failures, infectious complications were responsible for 75% (33/44) and mechanical complications for 25% (11/44). Peritonitis was the leading infectious complication (21/33) and outflow obstruction was the leading mechanical complication (9/11).
Conclusion:
In terms of long-term maintenance of access, CAPD is superior to HD, especially in the elderly or diabetics. Prevention and proper management of peritonitis may prolong the peritoneal catheter survival.
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