Overview of Continuous Ambulatory Peritoneal Dialysis —1990

Abstract

As of early 1990, the number of patients maintained on chronic peritoneal dialysis world-wide approached 50,000. In the United States, approximately 80% were on continuous ambulatory peritoneal dialysis (CAPD) while 15% used cycler techniques such as continuous cyclic peritoneal dialysis or nightly peritoneal dialysis. In other countries, the percentage of patients on chronic peritoneal dialysis on CAPD is presumably even higher. Studies from North America, Europe, and Australia-New Zealand all agree that mortalities on CAPD and hemodialysis are not significantly different if populations with similar characteristics are compared. Technique survivals have tended to be lower in CAPD than in hemodialysis, even with population adjustments. Differences in technique survival can, in part, be attributed to the tendency for patients to transfer from CAPD to hemodialysis after severe or frequent peritonitis. However, evidence continues to accumulate from multiple countries that disconnect devices, such as the Y-set, can reduce the rate of peritonitis to less than one episode per 20 patient months. As peritonitis rates decrease, transfer rates decrease and technique survival improves. In some Y-set populations, technique survivals similar to hemodialysis have been reported. Current research interests in CAPD are focused on improved catheters, exit site care, verification that CAPD may preserve GFR better than hemodialysis, manipulation of lymphatic absorption to enhance ultrafiltration, more sophisticated models of peritoneal transport, improved control of calcium and phosphorus without aluminum, and individualization of peritoneal dialysis prescriptions to assure adequacy.