Do Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis Have the Same Clinical Outcomes? A Ten-year Cohort Study in Taiwan.

Chao-Hsiun Tang,Kuan-Chih Huang,Te-Chao Fang,Yu-Ting Wu,Siao-Yuan Huang,Tso-Hsiao Chen,Yuh-Mou Sue,Chia-Chen Wang

doi:10.1038/srep29276

Abstract

This paper reports a comprehensive comparison for mortality and technique failure rates between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) in Taiwan. A propensity-score matched cohort study was conducted by retrieving APD and CAPD patients identified from the Taiwan National Health Insurance Research Database between 2001 and 2010. The main outcomes were the 5-year mortality and technique failure rates. Further analyses were then carried out based upon the first (2001–2004), second (2005–2007), and third (2008–2010) sub-periods. Similar baseline characteristics were identified for APD (n = 2,287) and CAPD (n = 2,287) patients. The proportion on APD therapy increased rapidly in the second sub-period. As compared to CAPD patients of this sub-period, APD patients had a significantly higher risk of mortality (HR, 1.37; 95% CI 1.09–1.72; p < 0.01) and technique failure (HR, 1.43; 95% CI, 1.10–1.86; p < 0.01), particularly in the first year after peritoneal dialysis commencement. However, APD patients had similar mortality and technique failure rates to those of CAPD patients throughout the full sample period and the first and third sub-periods. These findings do not suggest the presence of a clear advantage of CAPD over APD. Differences observed between these two modalities might be attributed to specials circumstances of sub-periods.

Highlights

Mortality is one of the most important outcomes to be taken into consideration when selecting dialysis modalities amongst patients entering ‘end-stage renal disease’ (ESRD)
The results revealed that as compared to the first sub-period, continuous ambulatory peritoneal dialysis (PD) (CAPD) patients had a lower risk of all-cause mortality (ACM) and technique failure (TF) in the other two sub-periods; no similar trend was discernible for the automated PD (APD) patients
We have found that as compared to CAPD patients, APD patients had a lower risk of developing peritonitis with the exception of the second sub-period

Summary

Introduction

Mortality is one of the most important outcomes to be taken into consideration when selecting dialysis modalities amongst patients entering ‘end-stage renal disease’ (ESRD). Previous ESRD registries have documented racial differences in the crude mortality rates of patients on dialysis, and whist the clinical outcomes of the two PD modalities have been compared in western countries, the ACM results have been somewhat inconsistent. Two studies undertaken in Mexico and Brazil reported that as compared to CAPD patients, APD patients had a better technique survival rate and significantly lower ACM17,19. Several factors may have potentially contributed to the variations in the results reported in the western studies, including geographic variations, racial and ethnic differences, patient choice bias, physician bias and differences in insurance payment scheme for APD modality; and APD has the distinct characteristic of short dwell times under automated devices, with such usage having increased over recent years. Our population-based study has been designed to facilitate a comprehensive comparison for ACM and TF rates amongst these two PD modalities

Methods

Results

Conclusion