A prospective, randomized multicenter study comparing APD and CAPD treatment.
OBJECTIVE
The goals for maintenance dialysis treatment are to improve patient survival, reduce patient morbidity, and improve patient quality of life. This is the first randomized prospective study comparing automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) treatment with respect to quality of life and clinical outcomes in relation to therapy costs.


METHODS
A prospective, randomized multicenter study.


METHODS
Three Danish CAPD units.


METHODS
Thirty-four adequately dialyzed patients with high or high-average peritoneal transport characteristics were included in the study.Twenty-five patients completed the study.


METHODS
After randomization, 17 patients were allocated to APD treatment and 17 patients to CAPD treatment for a period of 6 months. Medical and biochemical parameters were evaluated at monthly controls in the CAPD units. Quality-of-life parameters were assessed at baseline and after 6 months by the self-administered short-form SF-36 generic health survey questionnaire supplemented with disease- and treatment-specific questions. Therapy costs were compared by evaluating dialysis-related expenses.


METHODS
Quality-of-life parameters, dialysis-related complications, dialysis-related expenses.


RESULTS
The quality-of-life studies showed that significantly more time for work, family, and social activities was available to patients on APD compared to those on CAPD (p < 0.001). Although the difference was not significant, there was a tendency for less physical and emotional discomfort caused by dialysis fluid in the APD group. Sleep problems, on the other hand, tended to be more marked in the APD group. Any positive effect of APD compared to CAPD on dialysis-related hospital days or complication rates could not be confirmed. With larger patient samples, it is possible, however, that a significant difference might have been achieved. The running costs for APD treatment were US $75 per day and for CAPD treatment US $61 per day.


CONCLUSIONS
If APD treatment can help to keep selected patients vocationally or socially active, paying the extra cost seems reasonable.
Bro
S
S
Department of Nephrology, Rigshospitalet, Copenhagen, Denmark.
Bjorner
J B
JB
Tofte-Jensen
P
P
Klem
S
S
Almtoft
B
B
Danielsen
H
H
Meincke
M
M
Friedberg
M
M
Feldt-Rasmussen
B
B
D003718:Denmark; D015314:Dialysis Solutions / Q000009:adverse effects; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000517:prevention & control; D017060:Patient Satisfaction; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000191:economics; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects / Q000191:economics; D011446:Prospective Studies; D011788:Quality of Life; D012893:Sleep Wake Disorders / Q000209:etiology; D012931:Social Environment; D013315:Stress, Psychological / Q000517:prevention & control; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
D015314:Dialysis Solutions