TECHNIQUE FAILURE IN PERITONEAL-DIALYSIS AND ITS IMPACT ON PATIENT SURVIVAL

Objective: To determine the frequency and causes of continuous ambulat ory peritoneal dialysis (CARD) technique failure and its effect on pat ient outcome. Design: Retrospective study of CAPD technique and patien t outcome. Setting: Teaching hospital renal unit. Patients: All 221 pa tients commencing CAPD over a 14-year period. Outcome measures: Outcom es assessed included patient survival and technique survival (with cha nge to hemodialysis being considered as technique failure). Results: C APD failure occurred in 46 patients, with a CAPD technique survival of 93%, 73%, and 63% at 1, 3, and 5 years after start of treatment. Peri tonitis was the major cause of technique failure. CAPD system had no e ffect on technique survival, despite the lower peritonitis rate in pat ients using Y-connection systems. Overall patient survival was 91%, 72 %, and 53% at 1, 3, and 5 years after start of treatment, with increas ing age and diabetes being associated with a worse outcome. There was a high early mortality after CAPD failure, with an actuarial survival of only 61% 1 year later. Conclusion: Failure of CAPD is an important problem, with peritonitis being the major cause, either directly, or i ndirectly by the later effects of damage to the peritoneal membrane wi th loss of dialysis adequacy. The high mortality in the period followi ng CAPD failure warrants careful monitoring of patients during this ph ase, along with efforts to optimize correctable factors such as nutrit ion, adequacy of the new form of dialysis, and treatment of residual s epsis.