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Clinical Efficacy and Morbidity Associated with Continuous Cyclic Compared with Continuous Ambulatory Peritoneal Dialysis

Carola W. H. de Fijter, MD; Liem P. Oe, MD; Jos J. P. Nauta, MA; Jan van der Meulen, MD; Henri A. Verbrugh, MD; Jan Verhoef, MD; and Ab J. M. Donker, MD
[+] Article and Author Information

From the Free University Hospital, Amsterdam, and the State University of Utrecht, Utrecht, the Netherlands. Requests for Reprints: C.W.H. de Fijter, MD, Department of Internal Medicine, Division of Nephrology, Free University Hospital, P.O. Box 7057, 1007 MB Amsterdam, the Netherlands. Acknowledgments: The authors thank their patients for their cooperation; the medical staff of the Renal Department of the Elisabeth Gasthuis, Haarlem, the Netherlands, for referring patients; and the medical and nursing staffs of the Free University Hospital's Renal Unit for their commitment. Grant Support: By the Dutch Ministry of Education and Sciences (Functieverruiming 1988).


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1994;120(4):264-271. doi:10.7326/0003-4819-120-4-199402150-00002
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Objective: To assess the clinical efficacy and morbidity of continuous cyclic peritoneal dialysis compared with continuous ambulatory peritoneal 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 randomly assigned to receive continuous ambulatory peritoneal dialysis with a Y-connector or continuous cyclic peritoneal dialysis and were followed prospectively.

Measurements: Patient and technique survival, dialysis adequacy, and (infectious) morbidity.

Results: Forty-one patients (median age, 56 years; range, 18 to 86 years) started continuous ambulatory peritoneal dialysis with a Y-connector (follow-up, 688 patient-months), and 41 patients (median age, 54 years; range 21 to 76 years) started continuous cyclic peritoneal dialysis (follow-up, 723 patient-months). The two groups showed no significant differences in adequacy of dialysis (as assessed by blood pressure control and laboratory and neurologic variables) and patient or technique survival. Renal transplant was the primary reason for discontinuing the assigned dialysis technique 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 admission, respectively (not significant). Peritonitis occurred significantly less often in those receiving continuous cyclic peritoneal dialysis (0.94 compared with 0.51 episodes per patient-year; P = 0.03). No difference in causative pathogens was observed. Exit site infection rate was 0.38 episodes per patient-year in both groups.

Conclusion: In an unselected patient group, continuous cyclic peritoneal dialysis was accompanied by significantly lower rates of peritonitis and dialysis-related hospital admission, whereas it was as effective as continuous ambulatory peritoneal dialysis with a Y-connector for patient and technique survival.

Figures

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Figure 1.
Clinical and laboratory variables over time for patients using continuous ambulatory peritoneal dialysis with a Y-connector and those using continuous cyclic peritoneal dialysis.PPP

Data (mean ±SD) are based on 41 (0 months), 39 (6 months), 24 (18 months), and 11 (24 months) patients in the former group and on 41, 39, 29, 24, and 13 patients in the latter group. **  < 0.02 compared with 6, 12, 18, and 24 months for both methods of dialysis. *  < 0.01 compared with 0 months for continuous cyclic peritoneal dialysis and < 0.02 compared with 0 and 6 months for continuous ambulatory peritoneal dialysis with a Y-connector. CAPd-Y = continuous ambulatory peritoneal dialysis with a Y-connector; CCPD = continuous cyclic peritoneal dialysis. MAP = mean arterial blood pressure.

Grahic Jump Location
Grahic Jump Location
Figure 2.
Kaplan-Meier estimates of the probability of remaining free of peritonitis.P

The median time to a first episode of peritonitis was 11 months in the patients using continuous ambulatory peritoneal dialysis with a Y-connector compared with 18 months in those using continuous cyclic peritoneal dialysis ( = 0.06).

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