Comparing automated peritoneal dialysis with continuous ambulatory peritoneal dialysis: survival and quality of life differences?
Comparing automated peritoneal dialysis with continuous ambulatory peritoneal dialysis: survival and quality of life differences?
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DOI：
10.1093/ndt/gfq607
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发表时间：
2011-05-01
影响因子：
6.1
通讯作者：
Fan, Stanley L. -S.
中科院分区：
文献类型：
--
作者：
Balasubramanian, Gowrie;McKitty, Khadija;Fan, Stanley L. -S.
背景。在英国，使用自动腹膜透析（APD）或连续动态腹膜透析（CAPD）存在很大差异。这可能是由于APD患者的生活质量和技术生存优势，尽管缺乏证据。我们对引发APD和CAPD的终末期肾脏疾病进行了一项单中心回顾性研究，收集了超过5年的前瞻性数据。PD模式基于患者偏好。在初次和1年随访时使用SF-36问卷评估健康状况。共纳入372例患者，其中APD 194例，CAPD 178例。CAPD患者通常比APD患者年龄更大，依赖性更强。单因素分析显示CAPD的技术生存率较低（相对失败风险1.46,95% CI 1.08-1.97）。但在多变量分析中，当共病加入到模型中时，PD模式不再是技术生存的重要预测因子。两组在残余肾功能下降方面无差异。基线CAPD患者健康状况（HS）较差；平均（SEM）身体和社会综合得分为32.3 (0.9)vs 36.5（0.9）和33.3 (1.2)vs 40.3（1.2）。1年后，CAPD和APD患者的HS评分相似，但HS评分的改善与基线评分相关（PD模式不是HS变化的独立预测因子）。本研究未显示APD在技术存活或HS方面比CAPD有任何优势。没有证据支持医生偏向于一种PD模式，两种模式都应该可供患者选择。
Background. There is a wide disparity in the use of automated peritoneal dialysis (APD) or continuous ambulatory peritoneal dialysis (CAPD) in the UK. This may be due to a perceived quality of life and technique survival advantage with APD, although evidence is lacking.Methods. We conducted a single-centre retrospective study of incident end-stage renal disease initiating APD and CAPD with data collected prospectively over 5 years. PD modality was based on patient preference. Health status was assessed using SF-36 questionnaires at initial and 1-year follow-up appointments.Results. Three hundred and seventy-two patients were included: 194 patients chose APD, and 178 patients chose CAPD. CAPD patients were generally older and more dependent than APD patients. Univariate analysis for technique survival was inferior for CAPD (relative risk for failure 1.46, 95% CI 1.08-1.97). But on multivariate analysis when comorbidity was added into the model, PD modality was no longer a significant predictor of technique survival. There was no difference in decline in residual renal function. Baseline CAPD patients had worse health status (HS); mean (SEM) physical and social composite scores were 32.3 (0.9) vs 36.5 (0.9) and 33.3 (1.2) vs 40.3 (1.2). After 1 year, HS scores for CAPD and APD patients were similar, but the improvement in HS scores correlated with baseline scores (PD modality was not an independent predictor of the change in HS).Conclusions. This study did not show any advantages of APD over CAPD in terms of technique survival or HS. There is no evidence to support physician bias towards one PD modality, and both should be available to allow patient choice.