Capd Viability: A Long-Term Comparison with Hemodialysis

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Abstract
Objective: To compare the long-term viability of continuous ambulatory peritoneal dialysis (CAPD) to that of hemodialysis (HD). Design: Retrospective study of patients of our institution starting dialysis between January 1,1981, and 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 ≥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.