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Four hundred and eighty CAPD and 373 HD patients started regular dialysis treatment between 1981 and 1987 in 6 dialysis centers. The CAPD patients were 6 years older, on average, than the HD patients and had more complicating conditions (43.3% with 3 or more coexisting risk factors versus 28.9% with coexisting complications). The 7-year patient survival rate was not significantly different. Cox's proportional hazards regression showed that age, cardiovascular disease, cerebrovasculardisease, peripheral vasculardisease, diabetes, malignancy and multisystem disease had significant adverse effects on patient survival. After correcting for the influence of these factors, no significant differences in patient survival were seen. However, after 53.5 years of age, the increase in the risk of death was significantly higher in HD than in CAPD patients. Technique survival was significantly different in the 6 centers and was better for HD than for CAPD. There was no statistically significant difference between CAPD and HD technique survival when peritonitis was eliminated as a cause of failure. Based on this 7 year analysis, CAPD would appear to be an excellent alternative to HD.

The purpose of this study was to evaluate the In vltroand in vivoefficacy of a new connection system for continuous ambulatory peritoneal dialysis (CAPO), called the T-set. With this system the patient wears a 27–cm extension line filled with Amuchina during the dwell time; the bag is made of a fill container linked to a drainage tube with a Y-shaped set. For bag exchange, only one connection is needed and this is subsequently flushed with the entire drainage volume.The in vitroefficacy of the system was tested with 20 sets filled with 10 mL of Amuchina and inoculated in the distallumen with 2.1x103 colony-forming units (cfu) of S. aureus.After an Incubation of 4–6 hours at 35–37°C, three dialysate samples per set were collected, respectively, at the beginning of drainage and filling. Al1120 samples were negative, whereas two control sets, filled with a phosphate-buffered saline, had positive drainage samples, and at least one positive Infusion sample, Indicating the efficacy of Amuchina in sterilizing the system under conditions simulating touch contamination.To evaluate the in vivoefficacy, safety, and acceptability of the T-system, a prospective randomized controlled trial was performed In seven centers: a control group (CG) of 56 patients (follow-up: 952.3 months, mean±SO: 17.0±7.8) was treated with a long branch (21 patients) or short branch (35 patients) Y-set and a test group (TG) of 66 patients (follow-up: 898.1 months, mean±SO: 13.6±7.8) with the T-set. The two groups were comparable for patient and dialysis characteristics. The incidence of peritonitis was 1143.3 months in the CG and 1129.0 months In the TG (p=NS). The percentage of patients without peritonitis was 67.8% In the CG and 68.2% In the TG (p=NS); the probability of remaining free from peritonitis was, respectively, 76% and 75% In the CG and in the TG at 1 year, and 66% and 60% at 2 years (p=NS). In the CG 26 patients and In the TG 21 patients were already on CAPO before the trial; among these 21 patients, 10 of 10 with the long Y-set and 4 of 11 with the short Y-set who transferred to the T-set preferred the latter for better handling (52.4%) or for less encumbrance (14.3%).

The patient survival (PS) and technique survival (TS) were evaluated in 1990 patients on continuous ambulatory peritoneal dialysis (CAPD) (males: 55.9%, mean age±SD: 58.4± 14.8 years), treated in 30 centers participating in the Italian PD Study Group, from 1980 to 1989 (follow-up: 3953 years; mean±SD: 2.02±1.86 years).The total PS was 50.7% at 4 years, compared to 73.3% of patients without clinical high -risk condition (HRC) at the beginning of CAPD. In this group (34.0%) PS was significantly higher (p<0.001) compared, respectively, to patients with cardiovascular disease (30.5%), diabetes (13.1%), and age ≥70 years (11.2%). The percentage of death reached the mean value of 11.3% per year without any statistically significant tendency to variation during the follow-up, despite the increased number of patients ≥65 years old and those with HRC (p<0.001).Cardiovascular diseases (47.3%) and cachexia (17.8%) were the most frequent causes of death, whereas the mortality due to peritonitis showed a progressive in crease in patients with peritonitis Incidence 1 ep/year (G4) compared to those with <0.5 ep/year (G2). Peritonitis (0.68 ep/year) was the most frequent cause of technique failure (30.0%), with clinical complications (18.2%) and peritoneal membrane failure (16.4%) as the second and third causes. The dropout percentage was 8.3% per year with a significant decrease over time (p=0.012) and a positive correlation with the reduction of peritonitis incidence (p=0.035). The total TS was 50.1% at 7 years, and it was significantly worse in G4 compared to G2. The TS was significantly better in patients 65 years of age than in younger ones, who had the same probability and risk of peritonitis, but a higher incidence of membrane failure. In those patients where CAPD was the second dialysis treatment TS was significantly worse (p<0.001), with a higher probability and risk of peritonitis. The TS was not affected by diabetes, and probability and relative risk of peritonitis were similar to that of non diabetic patients.

Objective To evaluate the efficacy and safety of a new peritoneal dialysis solution with 33 mmol/L bicarbonate.Design In an acute, prospective, randomized crossover study, 8 patients were randomized in two groups of 4. On the first study day, the first group performed two consecutive 4-hour exchanges with a dialysis solution containing 35 mmol/L lactate: the first exchange with 13.6 g/Land the second with 38.6 g/L dextrose. On the second study day, the same type of exchanges were performed with bicarbonate. The second group underwent the same treatment, but used bicarbonate solutions on the first day and control solutions on the second study day. Thirty-three patients participated in a 2-month prospective and randomized study. After a 4-week baseline period using solutions containing 40 mmol/L lactate, the patients were dialyzed with either 33 mmol/L bicarbonate solutions or 40 mmol/L lactate solutions.Setting Peritoneal dialysis units at the University Hospital of Brescia and the Niguarda Hospital of Milan, Italy.Results Acute study: Control and bicarbonate solutions had similar effects on blood chemistries and peritoneal transport. Chronic study: Mean venous bicarbonate concentrations remained unchanged in the control group (26.6 -27.2 mmol/L), but decreased significantly in the bicarbonate group from 28.8 mmol/L at the start of the study to 23.0 mmol/L after 2 months of bicarbonate administration. Other biochemical parameters remained unchanged.Conclusion A peritoneal dialysis solution with a bicarbonate level of 33 mmol/L does not adequately correct uremic acidosis.

Objective To compare the long-term viability of continuous ambulatory peritoneal dialysis (CAPD) to that of hemodialysis (HD).Design Retrospective study of patients of our institution starting dialysis between January 1,1981, and December 31, 1993, and surviving for at least 2 months.Patients Five hundred and seventy-eight new patients (51.3% on CAPD and 48.6% on HD).Main Outcomes Studied Cox -adjusted assessment of patient and technique survival, and of technique success. Differences in results for two successive periods of time.Results Patient survival did not differ between CAPD and HD after adjusting for age and comorbidity, and significantly improved in the second part of the follow-up (1987 -1993). Technique failure was significantly higher on CAPD, in which it was inversely related to age. The probability of a patient continuing on the first method of dialysis (“technique success”) was significantly lower on CAPD than on HD, but the difference decreased progressively with age and disappeared in patients ≥75 years.Conclusion CAPD is as effective as HD in preserving life in uremic patients in the long-term, and gives better results in the older elderly. In adults, the lower technique success rate may not be a problem for patients with access to a good transplantation program; for others, this drawback must be weighed against the advantages of home treatment.

During 1981–1984, at our center 6/75 patients on CAPD and 1/86 on HD demonstrated a recovery of renal function. This and the observation that diuresis was maintained on CAPD, led us to study urine output (UO) and creatinine clearance (CrCI) in 41 patients on CAPD (CAPDp) and 45 on HD (HDp) without the use of diuretics. CAPDp had a decline in diuresis from 1201 ± 379 mI/day to 731 ± 572 (p < 0.01). HDp diuresis decreased from 1233 ± 439 to 438 ± 568 (p < 0.01). Creatinine clearance: HDp 5.8 ± 1.6 ml/min before, 1.3 ± 1.5 after; CAPDp 6.4 ± 2.0 before, 3.9 ± 2.9 after. After one year, HDp showed a significant drop in diuresis; three years passed before CAPDp had significant drop. Patients with glomerulonephritis showed the same trend on HD and CAPD. CAPDp with interstitial nephropathy had a smaller mean annual decrease in UO and CrCI, compared to HDp. CAPDp with nephroangiosclerosis showed less decrease in diuresis compared to HDp. These data confirm that, com pared to HD, CAPD treatment maintains residual renal function even in patients not using diuretics, and suggest that CAPD is a treatment of choice for those considered likely to recover renal function.Some workers have reported a slow decline in residual renal function and diuresis in patients on CAPD (1,2,3). Rottembourg (1), in particular, suggests that diuretics may have helped his patients to maintain diuresis.In 161 dialyzed patients (75 on CAPD, 86 on HD) who started dialysis between 1981 and 1984, six CAPD patients recovered renal function but only one HD patient. This disparity led us to inquire whether when compared to HD, CAPO enables us to maintain satisfactory, long-term diuresis, without the use of diuretics.

Serum ferritin, hematocrit (Ht) and hemoglobin (Hb) were studied in seven patients treated with hemodialysis (HD) who later switched to continuous ambulatory peritoneal dialysis (CAPD). No iron supplements were given during the study. During the whole observation period (12 months on HD and 12 months on CAPD), there was a progressive decrease in serum ferritin during HD, accompanied by a progressive drop in Hb and Ht; on the contrary, on CAPD, Hb and Ht showed a sharp increase despite further ferritin reduction. The CAPD ferritin drop was not due to peritoneal loss of iron or ferritin, which appeared negligible. We propose that the increase in both Ht and Hb in CAPD is due to the removal of toxic factor(s) inhibiting erythropoiesis, which allow(s) increased iron utilization, and consequently a reduction in serum-ferritin levels.Anemia of chronic renal failure is a complex event to which many factors may contribute -reduced erythrocyte survival, hemolysis, iron losses from gastrointestinal leakage, reduced erythropoiesis, presence of inhibitors of erythropoiesis (1).