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. 2016 Jul 8:6:29276.
doi: 10.1038/srep29276.

Do Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis Have the Same Clinical Outcomes? A Ten-year Cohort Study in Taiwan

Chao-Hsiun Tang  1 , Tso-Hsiao Chen  2   3 , Te-Chao Fang  2   3 , Siao-Yuan Huang  1 , Kuan-Chih Huang  1 , Yu-Ting Wu  1 , Chia-Chen Wang  4 , Yuh-Mou Sue  2   3
Affiliations

Do Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis Have the Same Clinical Outcomes? A Ten-year Cohort Study in Taiwan

Chao-Hsiun Tang et al. Sci Rep. .

Abstract

This paper reports a comprehensive comparison for mortality and technique failure rates between automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) in Taiwan. A propensity-score matched cohort study was conducted by retrieving APD and CAPD patients identified from the Taiwan National Health Insurance Research Database between 2001 and 2010. The main outcomes were the 5-year mortality and technique failure rates. Further analyses were then carried out based upon the first (2001-2004), second (2005-2007), and third (2008-2010) sub-periods. Similar baseline characteristics were identified for APD (n = 2,287) and CAPD (n = 2,287) patients. The proportion on APD therapy increased rapidly in the second sub-period. As compared to CAPD patients of this sub-period, APD patients had a significantly higher risk of mortality (HR, 1.37; 95% CI 1.09-1.72; p < 0.01) and technique failure (HR, 1.43; 95% CI, 1.10-1.86; p < 0.01), particularly in the first year after peritoneal dialysis commencement. However, APD patients had similar mortality and technique failure rates to those of CAPD patients throughout the full sample period and the first and third sub-periods. These findings do not suggest the presence of a clear advantage of CAPD over APD. Differences observed between these two modalities might be attributed to specials circumstances of sub-periods.

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Figures

Figure 1
Figure 1. Enrollment of study participants.
Figure 2
Figure 2. Total numbers of APD and CAPD patients (bar chart) and percentage of APD patients to total PD patients (solid line).
Figure 3
Figure 3
Kaplan-Meier analyses of (a) patient survival and (b) technique survival probabilities, by cohort periods.
Figure 4
Figure 4
Adjusted hazard ratios of APD to CAPD from the final multivariate model for (a) all-cause mortality and (b) technique failure, by year. The APD patients had a significantly higher risk of all-cause mortality in the 2005–2007 sub-period, particularly in the 1st and 3rd years. In contrast, a lower risk of all-cause mortality in the 2001–2004 sub-period was found, particularly in the 1st year. The adjusted hazard ratios of the technique failure fluctuated with a notably higher risk in the 1st and 2nd years of the 2005–2007 sub-period and a considerably lower risk in the 2nd and 4th years of the 2001–2004 sub-period. Patients were followed till December 31, 2011.
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References

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