Trends in CAPD technique failure: Canada, 1981-1997

Objective: Although important enhancements to continuous ambulatory peritoneal dialysis (CAPD) have occurred since its inception, few studies have explicitly evaluated trends over time in CAPD technique failure rates. To assist in quantifying the net benefit of improvements to CAPD for patient outcomes, we examined trends in technique failure rates among Canadian CAPD patients. Patients: Patients initiating renal replacement therapy on CAPD (n = 7110) between 1981 and 1997. Main Outcome Measures:Technique failure (Le., switch to hemodialysis). Results: Total follow-up was 12 831 patient-years (pt-yr). There were 1976 technique failures, for a crude CAPD failure rate of 154.0/1000 pt-yr. Technique failure rate ratios (RR) estimated using Poisson regression and adjusted for age, gender, race, province, primary renal diagnosis, and follow-up time, were significantly reduced for the 1990-93 [RR = 0.75,95% confidence interval (Cl) = (0.68,0.83)],1994-95 [RR = 0.83, Cl (0.75,0.93)], and 1996-97 [RR = 0.78, Cl (0.70,0.87)] calendar periods relative to 1981-89 (RR = 1, reference). Among cause-specific technique failure rates, the greatest improvement was observed for peritonitis-attributable technique failure, with RR = 0.46, Cl (0.41, 0.50) for 1990-97 relative to 1981-89. However, rates of technique failure due to inadequate dialysis were significantly elevated for the 1990-97 period [RR = 1.68, Cl (1.44,1.96)]. Conclusions:The collection of more detailed data on practice patterns would enable future studies to elucidate the cause-and-effect relationship between CAPD descriptors and technique failure, and hence assist in clinical decision-making.