Korean J Med.
1998 Sep;55(3):366-374.
Clinical Observation of Continuous Ambulatory Peritoneal Dialysis (CAPD) and Hemodialysis (HD) patients
- Affiliations
-
- 1Department of Internal Medicine, Bong Saeng Hospital, Pusan, Korea.
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.