Survival on chronic peritoneal dialysis: have results improved in the 1990s?

One hundred and seventy patients were treated with home peritoneal dialysis (PD) in our unit between 1986 and 1994. During this time lapse, several technical improvements were included in our practice. Among others there were: Swan neck permanent catheters, Y-systems, and automated home PD (APD). We reviewed our experience, to assess if these improvements had any impact on patient and technique survival, comparing patients who started PD between 1986 and 1989 (group A), with those who started PD between 1990 and 1994 (group B). Both groups had a comparable basal comorbidity, except for a higher proportion of elderly patients in group B (mean age 48 vs 58 years, p < 0.01). The incidence of peritonitis was lower in group B, while there were no differences in the rates of catheter-related infection or hospital admission. Also, there were no significant differences in patients or technique survival. The increasing presence of elderly patients in our PD unit was, apparently, determinant for the evolution of patient survival. On the other side, technical improvements had a marginal impact on technique survival. A good general PD survival in both groups, with few patients changing to hemodialysis (HD), may explain the lack of significant differences. In addition, peritonitis and inadequate PD/ultrafiltration (UF) were replaced by abdominal surgical events and social reasons as the main causes for PD failure in the second phase of the study.