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Which treatment for which patient in the future? Possible modifications in CAPD
R Maiorca1, G Cancarini, G Brunori
1Chair of Nephrology, University of Brescia, Division of Nephrology, Spedali Civili Brescia, Italy.
Summary
Long-term survival is similar for continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) patients. While drop-out rates are increasing for CAPD, patient survival is not falsely improved by these drop-outs.
Area of Science:
- Nephrology
- Internal Medicine
- Clinical Medicine
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) are major renal replacement therapies.
- Long-term outcomes and patient survival differences between CAPD and HD require ongoing evaluation.
Purpose of the Study:
- To compare long-term patient survival, method survival, causes of death, and drop-out rates between CAPD and HD.
- To investigate factors influencing survival, including nutritional status and dialysis adequacy.
Main Methods:
- A retrospective study of 578 unselected new patients (51% CAPD, 49% HD) from 1981-1993.
- Survival analysis adjusted for patient selection biases.
- A prospective study of 60 CAPD and 34 HD patients assessed nutritional status and dialysis adequacy (Kt/V).
Main Results:
- Adjusted long-term survival was similar for CAPD and HD up to 10 years.
- Method survival showed longer retention on HD (7 years) compared to CAPD (3.5 years).
- Drop-out rates for CAPD are increasing, primarily due to patient/partner burnout, and malnutrition is more frequent in CAPD patients, except the elderly. Dialysis adequacy (Kt/V) significantly impacted survival in both groups.
Conclusions:
- CAPD and HD offer comparable long-term patient survival when adjusted for selection biases.
- Strategies to mitigate CAPD drop-out, such as automated PD, are needed.
- Optimizing dialysis adequacy is crucial for improving survival in both CAPD and HD patients.