Clinical Observation of Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) patients / 대한내과학회지

ABSTRACT

OBJECTIVE: The selection of dialysis modalities for end-stage renal disease patient is often a complex decision process involving considerations of efficacy in terms of life maintenance, quality of life, convenience and cost. In order to facilitate informed decisions, we have compared the clinical outcome of CAPD and HD patients. METHODS: From May 1992 to May 1997, we observed the followings patients` survival rate, the causes of death in CAPD and HD patients, the frequency of CAPD peritonitis, CAPD catheter survival rate and the causes of catheter removal. Patients were categorized in the following ways DM and non-DM, alive or expired, above and below the age of 60 years, and treatment duration of more or less than 5 years. Six items (serum albumin, serum creatinine, hemoglobin, BMI, NPCR and KT/V) were measured, their values were evaluated and compared with each group using univariated statistics. RESULTS: The total number of patients was 508 (369 CAPD, 139 HD). 58 of them expired during the observation period. The overall 5 year patient survival rate was 81.4% for CAPD, 80.5% for HD, and 57.8% for CAPD with DM and 25% for HD with DM using the Kaplan-Meier method. In the CAPD group, the frequency of peritonitis was 0.52 /pt, yr; the 5 year technical survival of the catheter was 80.5%. 42 (88%) of 48 technical failures of the catheter were removed due to peritonitis. Regardless of the modes of replacement therapy used to treat DM and non-DM groups, the DM patients had longer duration of admission, older age, lower serum albumin and serum creatinine levels , and a lower 5 year patient survival rate than the non-DM group. Death in CAPD and HD was positively correlated with a long duration of admission and old age; CAPD patients who expired had lower serum albumin, smaller BMI and more frequent peritonitis than the surviving group. CONCLUSION: 1. There was no significant difference in the 5 year patient survival rate between CAPD and HD (81.4% in CAPD, 80.5% in HD). 2. DM patients had lower serum albumin, creatinine and BUN levels than non-DM patients. 3. The mortality rate was positively correlated with old age and duration of admission in CAPD and HD ; frequent CAPD peritonitis, lower serum albumin and small BMI in CAPD were also positively correlated with the death rate. 4. The higher the serum albumin and NPCR, the higher the survival rate for CAPD patients. 5. The serum creatinine was lower in patients above 60 years old and in those treated more than 5 years. 6. The DM group had a higher mortality rate than the non-DM group; the DM CAPD group had a higher 5 year survival rate than the DM HD group but it was not statistically significant.