Superior survival of high transporters treated with automated versus continuous ambulatory peritoneal dialysis

• Published in: Nephrology, dialysis, transplantation Vol. 25; no. 6; pp. 1973 - 1979
• Main Authors: Johnson, David W., Hawley, Carmel M., McDonald, Stephen P., Brown, Fiona G., Rosman, Johan B., Wiggins, Kathryn J., Bannister, Kym M., Badve, Sunil V.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.06.2010
• Subjects: Adult; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Australia - epidemiology; automated peritoneal dialysis; Automation; Biological and medical sciences; Biological Transport, Active; continuous ambulatory peritoneal dialysis; Emergency and intensive care: renal failure. Dialysis management; Female; Humans; Intensive care medicine; Kaplan-Meier Estimate; Kidney Failure, Chronic - mortality; Kidney Failure, Chronic - physiopathology; Kidney Failure, Chronic - therapy; Male; Medical sciences; Middle Aged; New Zealand - epidemiology; outcomes; patient survival; Peritoneal Dialysis - methods; Peritoneal Dialysis - mortality; Peritoneal Dialysis, Continuous Ambulatory - mortality; peritoneal equilibration test; Peritoneum - physiopathology; Permeability; Proportional Hazards Models; Registries; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Treatment Outcome; New Zealand; Australia; Kidney disease; Human; Urinary system disease; Prognosis; patient survival; Hemodialysis; continuous ambulatory peritoneal dialysis; Survival; Peritoneal dialysis; automated peritoneal dialysis; Extrarenal dialysis; Treatment; outcomes; Renal failure; Equilibration; Ambulatory; Comparative study; peritoneal equilibration test
• ISSN: 0931-0509; 1460-2385
• DOI: 10.1093/ndt/gfp780

Background. Automated peritoneal dialysis (APD) is widely recommended for the management of high transporters by the International Society of Peritoneal Dialysis (ISPD), although there have been no adequate studies to date comparing the outcomes of APD and continuous ambulatory peritoneal dialysis (CAPD) in this high risk group. Methods. The relative impact of APD versus CAPD on patient and technique survival rates was examined by both intention-to-treat (PD modality at Day 90) and ‘as-treated’ time-varying Cox proportional hazards model analyses in all patients who started PD in Australia or New Zealand between 1 April 1999 and 31 March 2004 and who had baseline peritoneal equilibration tests confirming the presence of high peritoneal transport status. Results. During the study period, 4128 patients commenced PD. Of these, 628 patients were high transporters on PD at Day 90 (486 on APD and 142 on CAPD). Compared to high transporters treated with CAPD, APD-treated high transporters were more likely to be younger and Caucasian, and less likely to be diabetic. On multivariate intention-to-treat analysis, APD treatment was associated with superior survival [adjusted hazard ratio (HR) 0.56, 95% confidence interval (CI) 0.35–0.87] and comparable death-censored technique survival (HR 0.88, 95% CI 0.64–1.21). Superior survival of high transporters treated with APD versus CAPD was also confirmed in supplemental as-treated analysis (HR 0.72, 95% CI 0.54–0.96), matched case-control analysis (HR 0.60, 95% CI 0.36–0.96) and subgroup analysis of high transporters treated entirely with APD versus those treated entirely with CAPD (HR 0.29, 95% CI 0.14–0.60). There were no statistically significant differences in patient survival or death-censored technique survival between APD and CAPD for any other transport group, except for low transporters, who experienced a higher mortality rate on APD compared with CAPD (HR 2.19, 95% CI 1.02–4.70). Conclusions. APD treatment is associated with a significant survival advantage in high transporters compared with CAPD. However, APD treatment is associated with inferior survival in low transporters.