Trends in CAPD Technique Failure: Canada, 1981–1997

Abstract

Objective Although important enhancements to continuous ambulatory peritoneal dialysis (CAPD) have occurred since its inception, few studies have explicitly evaluated trends over time in CAPD technique failure rates. To assist in quantifying the net benefit of improvements to CAPD for patient outcomes, we examined trends in technique failure rates among Canadian CAPD patients. Patients Patients initiating renal replacement therapy on CAPD ( n = 7110) between 1981 and 1997. Main Outcome Measures Technique failure ( i.e., switch to hemodialysis). Results Total follow-up was 12 831 patient-years (pt-yr). There were 1976 technique failures, for a crude CAPD failure rate of 154.0/1000 pt-yr. Technique failure rate ratios (RR) estimated using Poisson regression and adjusted for age, gender, race, province, primary renal diagnosis, and follow-up time, were significantly reduced for the 1990–93 [RR = 0.75, 95% confidence interval (CI) = (0.68, 0.83)], 1994–95 [RR = 0.83, CI (0.75, 0.93)], and 1996–97 [RR = 0.78, CI (0.70, 0.87)] calendar periods relative to 1981–89 (RR = 1, reference). Among cause-specific technique failure rates, the greatest improvement was observed for peritonitis-attributable technique failure, with RR = 0.46, CI (0.41, 0.50) for 1990–97 relative to 1981–89. However, rates of technique failure due to inadequate dialysis were significantly elevated for the 1990–97 period [RR = 1.68, CI (1.44, 1.96)]. Conclusions The collection of more detailed data on practice patterns would enable future studies to elucidate the cause-and-effect relationship between CAPD descriptors and technique failure, and hence assist in clinical decision-making.

Predictors of Peritonitis, Hospital Days, and Technique Survival for Peritoneal Dialysis Patients in a Managed Care Setting

“…The 2-year technique survival for our study patients was 63%. Peritonitis was strongly associated with technique failure in our patients, a finding that has been confirmed by others (23)(24)(25). The low peritonitis rates seen in our study help to explain the high technique survival we observed.…”

Prevention of infectious complications in peritoneal dialysis: best demonstrated practices

“…Peritonitis not only is the leading cause of technique failure but also contributes to mortality. [3][4][5][6][7][8][9][10][11][12][13][14][15] In a single center study of a PD cohort of 516 adults, the rate of death from all infections or sepsis was 30 per 1000 dialysis years at risk. 8 Ninety-two percent of these deaths due to infection were related to peritonitis.…”

“…1 In other parts of the world, infection also continues to be the second most common cause of death in PD patients. 9 Peritonitis also continues to be the leading cause of technique failure, [9][10][11] and for years has been a leading cause of hospitalization. 12 Therefore, to improve outcomes in peritoneal dialysis patients, attention must be focused on preventing peritonitis.…”

A study on the non-infectious complications of continuous ambulatory peritoneal dialysis

“…Non-infectious complications of CAPD are increasing in relative importance due to success in decreasing the rate of peritonitis. Catheter related problems are the major causes of technique failure and account for approximately 20% of change to HD [2,3].…”