In Younger Dialysis Patients, Automated Peritoneal Dialysis is Associated with Better Long-Term Patient and Technique Survival than is Continuous Ambulatory Peritoneal Dialysis

2011 ◽  
Vol 31 (3) ◽  
pp. 301-307 ◽  
Author(s):  
Chiao-Yin Sun ◽  
Chin-Chan Lee ◽  
Yu-Yin Lin ◽  
Mai-Szu Wu
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Age Groups ◽  
Nutrition Status ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Technique Survival ◽  
Adjusted Risk ◽  
Technique Failure ◽  
Overall Mortality

BackgroundIn the U.S. Renal Data System registry, technique and patient survival are similar with automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). The clinical outcomes of APD and CAPD in various age groups have not been clarified.ObjectivesWe investigated whether patient and technique survival are different for incident dialysis patients treated with APD or CAPD in two age groups.MethodsOur retrospective study of prospectively collected data included 282 incident peritoneal dialysis (PD) patients (161 on APD, 121 on CAPD). Patients on PD for less than 3 months were excluded. The patients were divided into those less than 65 years of age and those 65 years of age or older. Overall mortality and technique failure were the primary endpoints of the study. Hazard ratios (HRs) for mortality and technique failure were calculated by the Cox proportional hazards model and were adjusted for age, sex, diabetes mellitus, initial peritoneal equilibration test (PET), weekly peritoneal and renal creatinine clearances, and PD caregiver (self or other).ResultsThe characteristics and clinical data were not significantly different between patients on APD and CAPD, except for age and sex. The adjusted risk for overall mortality was not different between patients on APD and CAPD (HR: 0.72; 95% CI: 0.44 to 1.20; p = 0.207). The adjusted risk for technique failure was lower in APD patients than in CAPD patients (HR: 0.58; 95% CI: 0.34 to 0.98; p = 0.041). In patients less than 65 years of age, those on APD had a significantly lower risk of mortality (HR: 0.35; 95% CI: 0.16 to 0.75; p = 0.007) and technique failure (HR: 0.52; 95% CI: 0.28 to 0.95; p = 0.034) than did those on CAPD. In patients 65 years of age and older, those on APD had risks for mortality (HR: 1.14; 95% CI: 0.53 to 2.46; p = 0.730) and technique failure (HR: 0.51; 95% CI: 0.17 to 1.50; p = 0.220) that were similar to those of patients on CAPD. Nutrition status, including serum albumin and protein catabolic rate, was not significantly different between patients on APD and on CAPD, in either younger or older patients.ConclusionsYounger Chinese patients on APD have better patient and technique survival than do those on CAPD. However, there is a strong possibility that this benefit may be confounded or accounted for by baseline differences between the APD and CAPD populations.

Comparison of patient survival and technique survival between continuous ambulatory peritoneal dialysis and automated peritoneal dialysis

2020 ◽  
Vol 40 (6) ◽  
pp. 563-572
Author(s):  
I-Kuan Wang ◽  
Tung-Min Yu ◽  
Tzung-Hai Yen ◽  
Shih-Yi Lin ◽  
Chia-Ling Chang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Lower Risk ◽  
Patient Survival ◽  
Diabetic Patients ◽  
Automated Peritoneal Dialysis ◽  
Technique Survival ◽  
Peritoneal Permeability ◽  
Male Patients ◽  
Technique Failure

Background: This retrospective cohort study compared patient survival and technique survival between patients on continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) using recent data at a single tertiary medical center in Taiwan. Methods: From medical records, we identified incident 459 CAPD patients and 266 APD patients on dialysis for at least 90 days and aged more than 18 years to estimate mortality and technique failure rates, and related hazard ratio (HR) and 95% confidence interval (CI) from 2007 to 2018. Results: There were more women (52.3%) in the CAPD group, whereas patients in the APD group were younger. Compared to CAPD patients, APD patients had a lower mortality rate (2.83 vs. 5.79 per 100 person-years) with an adjusted HR of 0.69 (95% CI = 0.47–1.02), and a lower technique failure rate (9.70 vs. 17.52 per 100 person-years) with an adjusted HR of 0.65 (95% CI = 0.51–0.83). Further subgroup analyses revealed that, compared to CAPD, APD was associated with a significant lower risk of technique failure in male patients, patients aged 50–65 years, diabetic patients, patients without cardiovascular disease (CVD), patients with higher peritoneal permeability, or patients initiating PD in an earlier era. Conclusions: The mortality risk was not significant between CAPD and APD patients. APD is associated with a lower risk of technique failure than CAPD, particularly for male patients, and patients aged 50–65 years, with diabetes, without CVD, with high or high average peritoneal permeability, or initiating PD in an earlier era.

scholarly journals Transperitoneal Calcium Balance in Anuric Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Patients

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Chieko Hamada ◽  
Yasuhiko Tomino
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Biochemical Parameters ◽  
Calcium Balance ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Intact Pth ◽  
Rapid Removal ◽  
The Difference ◽  
Short Time

Backgrounds. Calcium (Ca) and bone metabolism in continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) patients show a remarkable difference depending on dialysis modalities. The levels of serum Ca and phosphate (P) in HD patients fluctuate contributing to the intermittent and rapid removal of plasma solute unlike in CAPD. Characteristics of plasma solute transport in automated peritoneal dialysis (APD) patients are resembled with that in HD. The purpose of the present study was to examine the difference of transperitoneal Ca removal between APD and CAPD anuric patients.Subjects and Methods. Twenty-three APD anuric patients were enrolled in this study. Biochemical parameters responsible for transperitoneal Ca removal in 24-hour and 4-hour peritoneal effluents were analyzed on CAPD and APD.Results. Transperitoneal Ca removal on APD was smaller compared with that on CAPD. The Ca removal was related to the ultrafiltration during short-time dwell. Decrease of the Ca removal during NPD induced by short-time dialysate dwell caused negative or small Ca removal in APD patients. The levels of intact PTH were increased at the end of PET.Conclusion. It appears that short-time dwell and frequent dialysate exchanging might suppress the transperitoneal Ca removal in anuric APD patients.

scholarly journals Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group.

1998 ◽  
Vol 9 (7) ◽  
pp. 1285-1292 ◽  
Author(s):  
D N Churchill ◽  
K E Thorpe ◽  
K D Nolph ◽  
P R Keshaviah ◽  
D G Oreopoulos ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Membrane Transport ◽  
Patient Survival ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Technique Survival ◽  
Survival Probabilities ◽  
The Mean ◽  
Technique Failure

The objective of this study was to evaluate the association of peritoneal membrane transport with technique and patient survival. In the Canada-USA prospective cohort study of adequacy of continuous ambulatory peritoneal dialysis (CAPD), a peritoneal equilibrium test (PET) was performed approximately 1 mo after initiation of dialysis; patients were defined as high (H), high average (HA), low average (LA), and low (L) transporters. The Cox proportional hazards method evaluated the association of technique and patient survival with independent variables (demographic and clinical variables, nutrition, adequacy, and transport status). Among 606 patients evaluated by PET, there were 41 L, 192 LA, 280 HA, and 93 H. The 2-yr technique survival probabilities were 94, 76, 72, and 68% for L, LA, HA, and H, respectively (P = 0.04). The 2-yr patient survival probabilities were 91, 80, 72, and 71% for L, LA, HA, and H, respectively (P = 0.11). The 2-yr probabilities of both patient and technique survival were 86, 61, 52, and 48% for L, LA, HA, and H, respectively (P = 0.006). The relative risk of either technique failure or death, compared to L, was 2.54 for LA, 3.39 for HA, and 4.00 for H. The mean drain volumes (liters) in the PET were 2.53, 2.45, 2.33, and 2.16 for L, LA, HA, and H, respectively (P < 0.001). After 1 mo CAPD treatment, the mean 24-h drain volumes (liters) were 9.38, 8.93, 8.59, and 8.22 for L, LA, HA, and H, respectively (P < 0.001); the mean 24-h peritoneal albumin losses (g) were 3.1, 3.9, 4.3, and 5.6 for L, LA, HA, and H, respectively (P < 0.001). The mean serum albumin values (g/L) were 37.8, 36.2, 33.8, and 32.8 for L, LA, HA, and H, respectively (P < 0.001). Among CAPD patients, higher peritoneal transport is associated with increased risk of either technique failure or death. The decreased drain volume, increased albumin loss, and decreased serum albumin concentration suggest volume overload and malnutrition as mechanisms. Use of nocturnal cycling peritoneal dialysis should be considered in H and HA transporters.

Is Technique Survival on Peritoneal Dialysis Better in Japan?

2006 ◽  
Vol 26 (2) ◽  
pp. 136-143 ◽  
Author(s):  
Hidetomo Nakamoto ◽  
Yoshindo Kawaguchi ◽  
Hiromichi Suzuki
Keyword(s):  
Peritoneal Dialysis ◽  
Survival Rate ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Failure Rate ◽  
Training Programs ◽  
Failure Rates ◽  
Peritoneal Membrane ◽  
Technique Survival ◽  
Technique Failure

Technique failure resulting in transfer to hemodialysis (HD) remains one of the most important challenges in long-term peritoneal dialysis (PD). In general, the proportion of patients transferring from PD to HD is much greater than the proportion transferring from HD to PD. However, technique failure rates differ considerably between and within countries. The question arises as to how technique failure rates in Japan compare with those in other countries. To address this issue, we reviewed the literature and our experience of 139 incident continuous ambulatory peritoneal dialysis (CAPD) patients from January 1995 to December 1999. Based on our review, we estimate that the 5-year technique survival rate in Japanese CAPD patients is approximately 70%, and that technique failure rate is around 7% per year. This rate is significantly lower than that in many other countries. The most common reasons for technique failure in Japan are peritoneal membrane failure, ultrafiltration loss, and inadequate dialysis. Another factor contributing to the low technique failure rate in Japan is an extremely low peritonitis rate. This may be related to good sanitation and excellent PD training programs. Peritoneal membrane failure continues to be the major challenge for long-term technique survival on PD in Japan.

scholarly journals Comparison of sodium removal in peritoneal dialysis patients treated by continuous ambulatory and automated peritoneal dialysis

2019 ◽  
Vol 32 (6) ◽  
pp. 1011-1019 ◽  
Author(s):  
Sarju Raj Singh Maharjan ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Fluid Balance ◽  
Automated Peritoneal Dialysis ◽  
Peritoneal Membrane ◽  
Dialysis Patients ◽  
Membrane Function ◽  
Peritoneal Dialysate ◽  
Hypertonic Glucose ◽  
Sodium Removal

Abstract Background Optimal fluid balance for peritoneal dialysis (PD) patients requires both water and sodium removal. Previous studies have variously reported that continuous ambulatory peritoneal dialysis (CAPD) removes more or equivalent amounts of sodium than automated PD (APD) cyclers. We therefore wished to determine peritoneal dialysate losses with different PD treatments. Methods Peritoneal and urinary sodium losses were measured in 24-h collections of urine and PD effluent in patients attending for their first assessment of peritoneal membrane function. We adjusted fluid and sodium losses for CAPD patients for the flush before fill technique. Results We reviewed the results from 659 patients, mean age 57 ± 16 years, 56.3% male, 38.9% diabetic, 24.0% treated by CAPD, 22.5% by APD and 53.5% APD with a day-time exchange, with icodextrin prescribed to 72.8% and 22.7 g/L glucose to 31.7%. Ultrafiltration was greatest for CAPD 650 (300–1100) vs 337 (103–598) APD p < 0.001, vs 474 (171–830) mL/day for APD with a day exchange. CAPD removed most sodium 79 (33–132) vs 23 (− 2 to 51) APD p < 0.001, and 51 (9–91) for APD with a day exchange, and after adjustment for the CAPD flush before fill 57 (20–113), p < 0.001 vs APD. APD patients with a day exchanged used more hypertonic glucose dialysates [0 (0–5) vs CAPD 0 (0–1) L], p < 0.001. Conclusion CAPD provides greater ultrafiltration and sodium removal than APD cyclers, even after adjusting for the flush-before fill, despite greater hypertonic usage by APD cyclers. Ultrafiltration volume and sodium removal were similar between CAPD and APD with a day fill.

Differences in predicting glucose absorption from peritoneal dialysate compared to measured absorption in peritoneal dialysis patients treated by continuous ambulatory peritoneal dialysis and ambulatory peritoneal dialysis cyclers

2020 ◽  
Vol 43 (7) ◽  
pp. 461-467
Author(s):  
Theerasak Tangwonglert ◽  
Andrew Davenport
Keyword(s):  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Glucose Absorption ◽  
Osmotic Gradient ◽  
Systematic Bias ◽  
Automated Peritoneal Dialysis ◽  
Dialysis Patients ◽  
Predictive Equations ◽  
Disease Outcomes

Background and aims: Glucose-containing peritoneal dialysates are used to generate an osmotic gradient for the convective removal of water and sodium. Predictive equations were developed to estimate glucose absorption without having to formally measure changes in dialysate glucose. In view of the changes in peritoneal dialysis prescriptions over time, we compared predicted and measured glucose absorption. Subjects/methods: We measured peritoneal glucose losses when peritoneal dialysis patients attended their first assessment of peritoneal membrane function, and compared this to glucose exposure and Kidney Disease Outcomes Quality Initiative, Grodstein and Bodnar predictive equations. Results: We studied 689 patients; 329 (56.9%) males, 53 (37.1%) diabetics, with mean age 57.1 ± 16.2 years, with 186 treated by automated peritoneal dialysis cyclers and 377 by automated peritoneal dialysis with a daytime icodextrin exchange and 126 by continuous ambulatory peritoneal dialysis. Using Bland -Altman analysis, all equations demonstrated systematic bias overestimating glucose absorption with increasing glucose absorption. For continuous ambulatory peritoneal dialysis patients, the Kidney Disease Outcomes Quality Initiative formula underestimated glucose absorption (bias 188 (−39 to 437) mmol/day, as did Grodstein (bias 37.9 (−105 to 29) mmol/day, whereas mean bias for Bodnar was −29 (−130 to 180)). There was systematic overestimation for all equations for both automated peritoneal dialysis with and without a daytime exchange, with increasing bias with greater glucose absorption. Conclusion: Although formally measuring peritoneal glucose absorption is time consuming and requires patient co-operation, current predictive equations overestimate glucose absorption and do not provide accurate estimations of glucose absorption particularly for automated peritoneal dialysis patients.

scholarly journals Serum albumin in patients on continuous ambulatory peritoneal dialysis--predictors and correlations with outcomes.

1993 ◽  
Vol 3 (8) ◽  
pp. 1501-1507 ◽  
Author(s):  
P G Blake ◽  
G Flowerdew ◽  
R M Blake ◽  
D G Oreopoulos
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Morbidity And Mortality ◽  
Stepwise Multiple Regression ◽  
Technique Survival ◽  
Patient Morbidity ◽  
Technique Failure

Serum albumin (SA) is a powerful predictor of patient morbidity and mortality in hemodialysis, but data are limited for continuous ambulatory peritoneal dialysis (CAPD). SA was monitored in 76 new CAPD patients over 222 6-month periods and mean SA was correlated with morbidity and mortality during those periods. The influence of initial SA on duration of technique survival was also investigated. To determine which factors best predict SA, correlations with patient demographics and with 6-month measurements of dialytic dose, protein intake, and peritoneal transport were sought. Mean SA overall was 34.1 +/- 3.3 g/L, and mean initial SA was 33.4 +/- 3.1 g/L. Mean SA was lower in diabetics and in those aged 65 or over. Mean SA tended to increase during the first year on CAPD, and this increase was maintained, except in patients aged 65 or over, where it tended to revert to initial values. SA correlated with hospital days (r = -0.20; P < 0.005), fatigue index (r = -0.20; P < 0.005), nerve conduction (P < 0.001), and a variety of laboratory values, and lower SA was associated with technique failure (P < 0.03) and death (P < 0.07). Initial, as well as ongoing, SA was predictive of technique failure (P < 0.05) and Cox proportional hazards regression showed that this predictive power was independent of age, sex, diabetes, and other factors (P = 0.05). The strongest predictors of low SA by stepwise multiple regression were diabetes, a higher dialysate-to-plasma creatinine equilibration ratio, older age, lower body weight, and shorter time on CAPD.(ABSTRACT TRUNCATED AT 250 WORDS)

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