Beduschi Gabriela de Carvalho, Figueiredo Ana Elizabeth, Olandoski Marcia, Pecoits-Filho Roberto, Barretti Pasqual, de Moraes Thyago Proenca
School of Medicine, UNESP, Botucatu, Brazil.
Graduate Program in Medicine and Health Sciences, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.
PLoS One. 2015 Jul 27;10(7):e0134047. doi: 10.1371/journal.pone.0134047. eCollection 2015.
The impact of peritoneal dialysis modality on patient survival and peritonitis rates is not fully understood, and no large-scale randomized clinical trial (RCT) is available. In the absence of a RCT, the use of an advanced matching procedure to reduce selection bias in large cohort studies may be the best approach. The aim of this study is to compare automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) according to peritonitis risk, technique failure and patient survival in a large nation-wide PD cohort.
This is a prospective cohort study that included all incident PD patients with at least 90 days of PD recruited in the BRAZPD study. All patients who were treated exclusively with either APD or CAPD were matched for 15 different covariates using a propensity score calculated with the nearest neighbor method. Clinical outcomes analyzed were overall mortality, technique failure and time to first peritonitis. For all analysis we also adjusted the curves for the presence of competing risks with the Fine and Gray analysis.
After the matching procedure, 2,890 patients were included in the analysis (1,445 in each group). Baseline characteristics were similar for all covariates including: age, diabetes, BMI, Center-experience, coronary artery disease, cancer, literacy, hypertension, race, previous HD, gender, pre-dialysis care, family income, peripheral artery disease and year of starting PD. Mortality rate was higher in CAPD patients (SHR1.44 CI95%1.21-1.71) compared to APD, but no difference was observed for technique failure (SHR0.83 CI95%0.69-1.02) nor for time till the first peritonitis episode (SHR0.96 CI95%0.93-1.11).
In the first large PD cohort study with groups balanced for several covariates using propensity score matching, PD modality was not associated with differences in neither time to first peritonitis nor in technique failure. Nevertheless, patient survival was significantly better in APD patients.
腹膜透析方式对患者生存率和腹膜炎发生率的影响尚未完全明确，且尚无大规模随机临床试验（RCT）。在缺乏RCT的情况下，在大型队列研究中使用先进的匹配程序以减少选择偏倚可能是最佳方法。本研究的目的是在一个全国性的大型腹膜透析队列中，根据腹膜炎风险、技术失败和患者生存率比较自动化腹膜透析（APD）和持续性非卧床腹膜透析（CAPD）。
这是一项前瞻性队列研究，纳入了BRAZPD研究中所有接受至少90天腹膜透析的新发病例患者。所有仅接受APD或CAPD治疗的患者使用最近邻法计算的倾向得分，针对15个不同的协变量进行匹配。分析的临床结局包括总死亡率、技术失败和首次发生腹膜炎的时间。对于所有分析，我们还使用Fine和Gray分析对存在竞争风险的曲线进行了调整。
匹配程序后，2890例患者纳入分析（每组1445例）。所有协变量的基线特征相似，包括：年龄、糖尿病、体重指数、中心经验、冠状动脉疾病、癌症、识字率、高血压、种族、既往血液透析史、性别、透析前护理、家庭收入、外周动脉疾病和开始腹膜透析的年份。与APD相比，CAPD患者的死亡率更高（标准化风险比1.44，95%置信区间1.21 - 1.71），但在技术失败（标准化风险比0.83，95%置信区间0.69 - 1.02）或首次腹膜炎发作时间（标准化风险比0.96，95%置信区间0.93 - 1.11）方面未观察到差异。
在第一项使用倾向得分匹配使几组协变量平衡的大型腹膜透析队列研究中，腹膜透析方式与首次腹膜炎发生时间或技术失败的差异无关。然而，APD患者的生存情况明显更好。
