抄録
BACKGROUND: The influence of the mode of dialysis on prognosis in patients with renal disease is controversial. This is at least in part because of heterogeneity of patient populations, who may be receiving either continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD). In the absence of randomized trials, epidemiological investigations present the best method for studying the problem.
METHODS: In order to determine the influence of the mode of dialysis on prognosis and on the cardiovascular system, erythropoiesis, and calcium metabolism, 36 patients having CAPD and 36 patients undergoing HD were selected for study. Patients were matched based on age, sex, and etiology of renal disease. A 5-year follow-up study was conducted.
RESULTS: Among CAPD patients there was 1 death due to severe infection, 1 from myocardial infarction, and 3 from congestive heart failure. In this group the average age were 58±3 years. Among HD patients there were 8 deaths due to congestive heart failure, 1 from cerebrovascular accidents, and 2 due to severe, infection. In this group the average age was 63±3 years. Six CAPD patients were transferred to HD, because of recurrent peritonitis or elevation of serum creatinine. Patients on CAPD had lower blood pressures, and patients on HD had lower total cholesterol levels. Other parameters were not significantly different between two groups, including the doses of erythropoietin and calcium supplements administered.
CONCLUSIONS: This study provides evidence that clinical outcomes in renal failure may depend to some extent upon the mode of dialysis. The results suggest that levels of blood pressure and serum total cholesterol should be taken into account when treating patients with either CAPD or HD, since both blood pressure and total cholesterol levels are likely to be important in contributing to mortality and morbidity in these patients.
