Woodrow G, Turney J H, Brownjohn A M
Renal Unit, General Infirmary at Leeds, U.K.
Perit Dial Int. 1997 Jul-Aug;17(4):360-4.
To determine the frequency and causes of continuous ambulatory peritoneal dialysis (CAPD) technique failure and its effect on patient outcome.
Retrospective study of CAPD technique and patient outcome.
Teaching hospital renal unit.
All 221 patients commencing CAPD over a 14-year period.
Outcomes assessed included patient survival and technique survival (with change to hemodialysis being considered as technique failure).
CAPD failure occurred in 46 patients, with a CAPD technique survival of 93%, 73%, and 63% at 1, 3, and 5 years after start of treatment. Peritonitis was the major cause of technique failure. CAPD system had no effect on technique survival, despite the lower peritonitis rate in patients using Y-connection systems. Overall patient survival was 91%, 72%, and 53% at 1, 3, and 5 years after start of treatment, with increasing age and diabetes being associated with a worse outcome. There was a high early mortality after CAPD failure, with an actuarial survival of only 61% 1 year later.
Failure of CAPD is an important problem, with peritonitis being the major cause, either directly, or indirectly by the later effects of damage to the peritoneal membrane with loss of dialysis adequacy. The high mortality in the period following CAPD failure warrants careful monitoring of patients during this phase, along with efforts to optimize correctable factors such as nutrition, adequacy of the new form of dialysis, and treatment of residual sepsis.
确定持续性非卧床腹膜透析（CAPD）技术失败的频率、原因及其对患者预后的影响。
对CAPD技术及患者预后的回顾性研究。
教学医院肾脏科。
14年间开始进行CAPD的所有221例患者。
评估的结局包括患者生存率和技术生存率（将转为血液透析视为技术失败）。
46例患者发生CAPD失败，治疗开始后1年、3年和5年的CAPD技术生存率分别为93%、73%和63%。腹膜炎是技术失败的主要原因。尽管使用Y型连接系统的患者腹膜炎发生率较低，但CAPD系统对技术生存率无影响。治疗开始后1年、3年和5年的总体患者生存率分别为91%、72%和53%，年龄增加和糖尿病与较差的预后相关。CAPD失败后早期死亡率较高，1年后精算生存率仅为61%。
CAPD失败是一个重要问题，腹膜炎是主要原因，腹膜炎可直接导致技术失败，或因腹膜损伤的后期影响导致透析充分性丧失而间接导致技术失败。CAPD失败后期间的高死亡率需要在此阶段对患者进行密切监测，并努力优化可纠正因素，如营养、新透析形式的充分性以及残余脓毒症的治疗。
