CAPD viability: A long-term comparison with hemodialysis

Objective: To compare the long-term viability of continuous ambulatory peritoneal dialysis (CARD) to that of hemodialysis (HD). Design: Retrospective study of patients of our institution starting dialysis between January 1, 1981, end December 31, 1993, and surviving for at least 2 months. Patients: Five hundred and seventy-eight new patients (51.3% on CAPD and 48.6% on HD). Main Outcomes Studied: Cox-adjusted assessment of patient and technique survival, and of technique success. Differences in results for two successive periods of time. Results: patient survival did not differ between CAPD and HD after adjusting for age and comorbidity, and significantly improved in the second part of the follow-up (1987 - 1993). Technique failure was significantly higher on CAPD, in which it was inversely related to age. The probability of a patient continuing on the first method of dialysis (''technique success'') was significantly lower on CAPD than on HD, but the difference decreased progressively with age and disappeared in patients greater than or equal to 75 years. Conclusion:CAPD is as effective as HD in preserving life in uremic patients in the long-term, and gives better results in the older elderly. In adults, the lower technique success rate may not be a problem for patients with access to a good transplantation program; for others, this drawback must be weighed against the advantages of home treatment.