A Multicenter, Selection-Adjusted Comparison of Patient and Technique Survivals on CAPD and Hemodialysis

Abstract

Four hundred and eighty CAPD and 373 HD patients started regular dialysis treatment between 1981 and 1987 in 6 dialysis centers. The CAPD patients were 6 years older, on average, than the HD patients and had more complicating conditions (43.3% with 3 or more coexisting risk factors versus 28.9% with coexisting complications). The 7-year patient survival rate was not significantly different. Cox's proportional hazards regression showed that age, cardiovascular disease, cerebrovasculardisease, peripheral vasculardisease, diabetes, malignancy and multisystem disease had significant adverse effects on patient survival. After correcting for the influence of these factors, no significant differences in patient survival were seen. However, after 53.5 years of age, the increase in the risk of death was significantly higher in HD than in CAPD patients. Technique survival was significantly different in the 6 centers and was better for HD than for CAPD. There was no statistically significant difference between CAPD and HD technique survival when peritonitis was eliminated as a cause of failure. Based on this 7 year analysis, CAPD would appear to be an excellent alternative to HD.

Role of rosiglitazone in lipopolysaccharide‐induced peritonitis: A rat peritoneal dialysis model

“…Although the rates of peritonitis have decreased significantly in recent years, the outcome of patients with peritonitis has not significantly improved despite the technical advances. [1][2][3] Peritoneal biopsies obtained from dialyzed patients show that the architecture of the peritoneum is severely damaged during peritonitis. 4 In addition, several lines of evidence, obtained from both patients with peritonitis and animal models, have shown that acute peritonitis is characterized by increased transport of small solutes and glucose as well as loss of protein and ultrafiltration.…”

Does Periodontal Disease Reflect Atherosclerosis in Continuous Ambulatory Peritoneal Dialysis Patients?

“…11 Yet, it has been reported that CAPD patients have higher adjusted mortality risk and more atherosclerotic changes than HD patients. 12,13 The majority of studies on the prevalence and importance of periodontal disease and related factors have focused on HD patients, 4,7,14 and data regarding CAPD patients are scarce. 15 Furthermore, a study by D'Aiuto et al 16 suggested that control of local periodontal infections was associated with a decrease in the levels of serum inflammatory markers.…”

Adequacy of Peritoneal Dialysis and Other Outcome‐Related Risk Factors: A Critical Appraisal

“…In a multicenter cohort study in England, a prior history of cardiovascular/cerebrovascular disease was an even stronger predictor of patient survival than age and diabetes (1 5). The multicenter study from Italy demonstrated the adverse effect of age and a variety of co-morbid factors (28). The studies from England ( 15) and Italy (28) identified no risk factor associated with transfer from CAPD to hemodialysis.…”

“…In 1991, Maiorca et al (28) reported the results of a six-center study in Italy that compared, after selection adjustment, the patient and technique survivals for patients starting treatment with hemodialysis and CAPD between 198 1 and 1987. While there were no differences detected between treatment modalities, the Cox proportional hazards regression model (25) revealed a significantly worse survival for age greater than 53.5 years, diabetes, malignancy, peripheral vascular disease, cerebrovascular disease, ischemic cardiomyopathy, and multisystem disease.…”