CLINICAL EFFICACY AND MORBIDITY ASSOCIATED WITH CONTINUOUS CYCLIC COMPARED WITH CONTINUOUS AMBULATORY PERITONEAL-DIALYSIS

Objective: To assess the clinical efficacy and morbidity of continuous cyclic peritoneal dialysis compared with continuous ambulatory perito neal dialysis with a Y-connector as renal replacement therapy. Design: Prospective, randomized study. Setting: University hospital. Patients : All new patients with end-stage renal failure consecutively entering the dialysis program from January 1988 through July 1991 were randoml y assigned to receive continuous ambulatory peritoneal dialysis with a Y-connector or continuous cyclic peritoneal dialysis and were followe d prospectively. Measurements: Patient and technique survival, dialysi s adequacy, and (infectious) morbidity. Results: Forty-one patients (m edian age, 56 years; range, 18 to 86 years) started continuous ambulat ory peritoneal dialysis with a Y-connector (follow-up, 688 patient-mon ths), and 41 patients (median age, 54 years; range 21 to 76 years) sta rted continuous cyclic peritoneal dialysis (follow-up, 723 patient-mon ths). The two groups showed no significant differences in adequacy of dialysis (as assessed by blood pressure control and laboratory and neu rologic variables) and patient or technique survival. Renal transplant was the primary reason for discontinuing the assigned dialysis techni que in both groups. The average number of hospitalizations per patient -year was 1.0 using continuous ambulatory peritoneal dialysis with a Y -connector and 0.6 per patient-year using continuous cyclic peritoneal dialysis (P = 0.02), with a mean duration of 10.8 and 9.6 days per ad mission, respectively (not significant). Peritonitis occurred signific antly less often in those receiving continuous cyclic peritoneal dialy sis (0.94 compared with 0.51 episodes per patient-year; P = 0.03). No difference in causative pathogens was observed. Exit site infection ra te was 0.38 episodes per patient-year in both groups. Conclusion: In a n unselected patient group, continuous cyclic peritoneal dialysis was accompanied by significantly lower rates of peritonitis and dialysis-r elated hospital admission, whereas it was as effective as continuous a mbulatory peritoneal dialysis with a Y-connector for patient and techn ique survival.