Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan.
Perit Dial Int. 2011 May-Jun;31(3):301-7. doi: 10.3747/pdi.2010.00072. Epub 2011 Jan 31.
In the U.S. Renal Data System registry, technique and patient survival are similar with automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD). The clinical outcomes of APD and CAPD in various age groups have not been clarified.
We investigated whether patient and technique survival are different for incident dialysis patients treated with APD or CAPD in two age groups.
Our retrospective study of prospectively collected data included 282 incident peritoneal dialysis (PD) patients (161 on APD, 121 on CAPD). Patients on PD for less than 3 months were excluded. The patients were divided into those less than 65 years of age and those 65 years of age or older. Overall mortality and technique failure were the primary endpoints of the study. Hazard ratios (HRs) for mortality and technique failure were calculated by the Cox proportional hazards model and were adjusted for age, sex, diabetes mellitus, initial peritoneal equilibration test (PET), weekly peritoneal and renal creatinine clearances, and PD caregiver (self or other).
The characteristics and clinical data were not significantly different between patients on APD and CAPD, except for age and sex. The adjusted risk for overall mortality was not different between patients on APD and CAPD (HR: 0.72; 95% CI: 0.44 to 1.20; p = 0.207). The adjusted risk for technique failure was lower in APD patients than in CAPD patients (HR: 0.58; 95% CI: 0.34 to 0.98; p = 0.041). In patients less than 65 years of age, those on APD had a significantly lower risk of mortality (HR: 0.35; 95% CI: 0.16 to 0.75; p = 0.007) and technique failure (HR: 0.52; 95% CI: 0.28 to 0.95; p = 0.034) than did those on CAPD. In patients 65 years of age and older, those on APD had risks for mortality (HR: 1.14; 95% CI: 0.53 to 2.46; p = 0.730) and technique failure (HR: 0.51; 95% CI: 0.17 to 1.50; p = 0.220) that were similar to those of patients on CAPD. Nutrition status, including serum albumin and protein catabolic rate, was not significantly different between patients on APD and on CAPD, in either younger or older patients.
Younger Chinese patients on APD have better patient and technique survival than do those on CAPD. However, there is a strong possibility that this benefit may be confounded or accounted for by baseline differences between the APD and CAPD populations.
在美国肾脏数据系统登记处，自动化腹膜透析（APD）和持续不卧床腹膜透析（CAPD）的技术和患者生存率相似。APD 和 CAPD 在不同年龄组的临床结果尚未阐明。
我们研究了在两个年龄组中，接受 APD 或 CAPD 治疗的新发病例透析患者的患者和技术生存率是否不同。
我们对前瞻性收集的数据进行了回顾性研究，包括 282 例新发病例腹膜透析（PD）患者（APD 组 161 例，CAPD 组 121 例）。排除 PD 治疗时间少于 3 个月的患者。将患者分为年龄小于 65 岁和年龄大于等于 65 岁两组。总死亡率和技术失败是本研究的主要终点。通过 Cox 比例风险模型计算死亡率和技术失败的风险比（HR），并根据年龄、性别、糖尿病、初始腹膜平衡试验（PET）、每周腹膜和肾肌酐清除率以及 PD 护理人员（自己或他人）进行调整。
APD 组和 CAPD 组患者的特征和临床数据除年龄和性别外无明显差异。APD 组患者的总死亡率风险与 CAPD 组患者无差异（HR：0.72；95%CI：0.44 至 1.20；p=0.207）。APD 组患者的技术失败风险低于 CAPD 组患者（HR：0.58；95%CI：0.34 至 0.98；p=0.041）。在年龄小于 65 岁的患者中，APD 组患者的死亡率（HR：0.35；95%CI：0.16 至 0.75；p=0.007）和技术失败（HR：0.52；95%CI：0.28 至 0.95；p=0.034）风险显著低于 CAPD 组患者。在年龄大于等于 65 岁的患者中，APD 组患者的死亡率（HR：1.14；95%CI：0.53 至 2.46；p=0.730）和技术失败（HR：0.51；95%CI：0.17 至 1.50；p=0.220）风险与 CAPD 组患者相似。APD 组和 CAPD 组患者的营养状况，包括血清白蛋白和蛋白分解率，在年轻或年长患者中均无显著差异。
年轻的中国 APD 患者的患者和技术生存率优于 CAPD 患者。然而，APD 和 CAPD 人群之间的基线差异可能导致或解释了这种获益的可能性。
