COST-CONTAINMENT IN CAPD PATIENTS WITH ULTRAFILTRATION FAILURE

Continuous ambulatory peritoneal dialysis (CAPD) using glucose-based s olutions is used increasingly to treat patients with renal failure. Ul trafiltration failure occurs in CAPD patients after a variable time; t he number of CAPD patients with ultrafiltration failure is therefore r ising; this presents a situation which could overwhelm the present Uni ted Kingdom haemodialysis resources. Icodextrin 7.5% is a new glucose- polymer-based CAPD solution best suited to the long dwell times that p resent the greatest challenge to patients with ultrafiltration failure . The icodextrin compassionate-use programme was set up to allow CAPD patients access to icodextrin before commercial availability. There wa s no rigid protocol; patients with ultrafiltration failure received ic odextrin (1.5 or 2L) for the long dwell for as long as it was benefici al. The outcome of the programme was analysed by life-table analysis f or (a) overall technique survival in all ultrafiltration failure patie nts in the programme, and (b) CAPD extension time in patients who eith er stayed in the programme or left it because of worsening ultrafiltra tion failure. 56 ultrafiltration failure patients were included in the programme. In this group, life-table analysis showed a technique surv ival of 38% after 1 year. Withdrawals were: 6 transplants, 6 deaths an d 23 transfers to haemodialysis. For CAPD extension time due to icodex trin, 36 patients were included: life-table analysis showed that 60% r emained on CAPD 12 months after starting icodextrin treatment. Overall , in patients with ultrafiltration failure, the inclusion of icodextri n in the dialysis prescription extended CAPD lifetime by an average of at least 1 year. At current United Kingdom costs, CAPD with the inclu sion of icodextrin represents a cost saving of approximately 1500 poun d per annum over hospital-based haemodialysis, as well as the benefit to the patient of remaining on the chosen modality of treatment.