Objective: To compare continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) with regard to long-term maintenance of access.
Design: Retrospective study of a four- to six-year time period at one center.
Patients: One hundred and twenty-two CAPD patients between December 1988 and December 1992, and 172 HD patients between May 1986 and December 1992.
Main outcome measure: Cumulative survival rate of peritoneal catheters and arteriovenous fistulas (AVF) was the main outcome measure. Variables affecting the survival rate including sex, age, presence or absence of diabetes, and type of AVF (autogenous or prosthetic graft) were assessed. The causes of peritoneal catheter failures were analyzed.
Results: The cumulative survival rate of all peritoneal catheters was significantly longer than the AVF survival rate (84% vs 74% at one year; 73% vs 61% at two years; and 63% vs 48% at three years) (p = 0.029). There were no differences in peritoneal catheter survival according to sex, age, or diabetes. Compared with AVF survival, peritoneal catheter survival was significantly longer in male (p = 0.0492), elderly (p = 0.0082), and diabetic (p = 0.0022) patients. Prosthetic graft and old age were risk factors for AVF survival. Of all peritoneal catheter failures, infectious complications were responsible for 75% (33/44) and mechanical complications for 25% (11/44). Peritonitis was the leading infectious complication (21/33) and outflow obstruction was the leading mechanical complication (9/11).
Conclusion: In terms of long-term maintenance of access, CAPD is superior to HD, especially in the elderly or diabetics. Prevention and proper management of peritonitis may prolong the peritoneal catheter survival.