COMPARISON OF PERITONEAL CATHETER SURVIVAL WITH FISTULA SURVIVAL IN HEMODIALYSIS

Objective: To compare continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis (HD) with regard to long-term maintenance of access. Design: Retrospective study of a four- to six-year time period at one center. Patients: One hundred and twenty-two CAPD patients between De cember 1988 and December 1992, and 172 HD patients between May 1986 an d December 1992. Main Outcome Measure: Cumulative survival rate of per itoneal catheters and arteriovenous fistulas (AVF) was the main outcom e measure. Variables affecting the survival rate including sex, age, p resence or absence of diabetes, and type of AVF (autogenous or prosthe tic graft) were assessed. The causes of peritoneal catheter failures w ere analyzed. Results: The cumulative survival rate of all peritoneal catheters was significantly longer than the AVF survival rate (84% vs 74% at one year; 73% vs 61% at two years; and 63% vs 48% at three year s) (p = 0.029). There were no differences in peritoneal catheter survi val according to sex, age, or diabetes. Compared with AVF survival, pe ritoneal catheter survival was significantly longer in male (p = 0.049 2), elderly (p = 0.0082), and diabetic (p = 0.0022) patients. Prosthet ic graft and old age were risk factors for AVF survival. Of all perito neal catheter failures, infectious complications were responsible for 75% (33/44) and mechanical complications for 25% (11/44). Peritonitis was the leading infectious complication (21/33) and outflow obstructio n was the leading mechanical complication (9/11). Conclusion: In terms of long-term maintenance of access, CAPD is superior to HD, especiall y in the elderly or diabetics. Prevention and proper management of per itonitis may prolong the peritoneal catheter survival.