Technique failure in peritoneal dialysis and its impact on patient survival

Objective: To determine the frequency and causes of continuous ambulatory peritoneal dialysis (CARD) technique failure and its effect on patient outcome. Design: Retrospective study of CAPD technique and patient outcome. Setting: Teaching hospital renal unit. Patients: All 221 patients commencing CAPD over a 14-year period. Outcome measures: Outcomes assessed included patient survival and technique survival (with change to hemodialysis being considered as technique failure). Results: CAPD failure occurred in 46 patients, with a CAPD technique survival of 93%, 73%, and 63% at 1, 3, and 5 years after start of treatment. Peritonitis was the major cause of technique failure. CAPD system had no effect on technique survival, despite the lower peritonitis rate in patients using Y-connection systems. Overall patient survival was 91%, 72%, and 53% at 1, 3, and 5 years after start of treatment, with increasing age and diabetes being associated with a worse outcome. There was a high early mortality after CAPD failure, with an actuarial survival of only 61% 1 year later. Conclusion: Failure of CAPD is an important problem, with peritonitis being the major cause, either directly, or indirectly by the later effects of damage to the peritoneal membrane with loss of dialysis adequacy. The high mortality in the period following CAPD failure warrants careful monitoring of patients during this phase, along with efforts to optimize correctable factors such as nutrition, adequacy of the new form of dialysis, and treatment of residual sepsis.