Comparison of home hemodialysis to continuous ambulatory peritoneal dialysis

Abstract

We evaluated prospectively various outcome measurements of patients assigned initially to continuous ambulatory peritoneal dialysis (CAPD) and home hemodialysis (HHD) from February 1979 to August 1981 and the causes for failures of the techniques. Morbidity was assessed by time in hospital/time on dialysis. Fifty-six patients were trained for CAPD and 37 for HHD. Those assigned to CAPD experienced an increased frequency of hospitalization (7.5% CAPD, 2.8% HHD, respectively) primarily due to episodes of peritonitis. There was also a higher modality failure rate (43% vs. 16%). However, the groups were not comparable in all respects. For example, the CAPD population included 21 patients with major cardiovascular diseases versus only three in the HHD group. The demographic characteristics of both populations including race, sex, age, income, place of residence, marital status, and education were similar. At the time of this study there is no direct evidence showing that healthy patients otherwise able to perform HHD may be maintained with less morbidity for a prolonged period utilizing CAPD. Therefore, we suggest that HHD is the home method of choice for patients able to proceed with this technique. CAPD may be indicated for patients in whom the period of home dialysis is expected to be relatively short and who would be otherwise unable to carry out home dialysis, for example, patients awaiting transplantation and those unable to be maintained on hemodialysis because of impaired cardiac function. To fully evaluate CAPD as a long-term maintenance therapy, a prospective trial must be performed.

A Comparative Study of Continuous Ambulatory Peritoneal Dialysis and Center Hemodialysis

“…This is in contrast to other reports in which more negative experience with CAPD was noted.2,20 In many studies, CAPD treatment is limited or preferentially allocated to the older, sicker, and higher-risk patients, 26,29 which is in marked contrast to the methods of patient selection for HHD. This discrepancy in patient allocation may account for the negative results reported by Rubin et al26 in comparing CAPD with HHD.…”

Suppressor Resident Peritoneal Macrophages and Peritonitis Incidence in Continuous Ambulatory Peritoneal Dialysis

“…Peritonitis can still be considered the most frequent complication in patients undergoing continuous ambula tory peritoneal dialysis (CAPD) [1], caused often by an impaired host peritoneal membrane defense which plays an important role in the development of recurrent in fections [2]. Many factors can be considered capable of reducing such a local antibacterial activity in some CAPD patients whether connected with uremic state or with treatment handlings [3].…”

End stage renal disease (ESRD) and the marital dyad

“…" CAPD who a~e lesB~suitable for h~modialysis. This includes diabetics ind patients with severe 6ardiovascular complicati~ns (Mion, 1981;Oreopoulos, 198~;Oreopaulos et al, 1981;Rubin, . -'Barnes.…”