Intervention Review

Continuous ambulatory peritoneal dialysis versus automated peritoneal dialysis for end-stage renal disease

  1. Kannaiyan S Rabindranath1,*,
  2. James Adams2,
  3. Tariq Z Ali3,
  4. Alison M MacLeod4,
  5. Luke Vale5,
  6. June D Cody6,
  7. Sheila A Wallace7,
  8. Conal Daly8

Editorial Group: Cochrane Renal Group

Published Online: 18 APR 2007

Assessed as up-to-date: 11 FEB 2007

DOI: 10.1002/14651858.CD006515


How to Cite

Rabindranath KS, Adams J, Ali TZ, MacLeod AM, Vale L, Cody JD, Wallace SA, Daly C. Continuous ambulatory peritoneal dialysis versus automated peritoneal dialysis for end-stage renal disease. Cochrane Database of Systematic Reviews 2007, Issue 2. Art. No.: CD006515. DOI: 10.1002/14651858.CD006515.

Author Information

  1. 1

    Churchill Hospital, Renal Unit, Oxford, UK

  2. 2

    Royal Berkshire Hospital, Renal Unit, Reading, UK

  3. 3

    Aberdeen Royal Infirmary, Renal Unit, Aberdeen, UK

  4. 4

    University of Aberdeen, Medicine and Therapeutics, Aberdeen, Scotland, UK

  5. 5

    University of Aberdeen, Health Economics, Aberdeen, UK

  6. 6

    University of Aberdeen, Cochrane Incontinence Review Group, Foresterhill, Aberdeen, UK

  7. 7

    University of Aberdeen, Health Services Research Unit, Aberdeen, Scotland, UK

  8. 8

    Western Infirmary Glasgow, Renal Unit, Glasgow, Scotland, UK

*Kannaiyan S Rabindranath, Renal Unit, Churchill Hospital, Oxford, OX3 7LJ, UK. ksrabi@yahoo.co.uk. samuelrabi@rediffmail.com.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 18 APR 2007

SEARCH

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Peritoneal dialysis (PD) can be performed either manually as in continuous ambulatory peritoneal dialysis (CAPD) or using mechanical devices as in automated PD (APD). APD has been considered to have several advantages over CAPD such as reduced incidence of peritonitis, mechanical complications and greater psychosocial acceptability.

Objectives

To assess the comparative efficacy of CAPD and APD in patients who are dialysed for end-stage renal disease (ESRD).

Search methods

We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Renal Group's specialised register and CINAHL. Authors of included studies were contacted, reference lists of identified RCTs and relevant narrative reviews were screened.
Date of most recent search: May 2006

Selection criteria

RCTs comparing CAPD with APD in patients with ESRD.

Data collection and analysis

Data were abstracted independently by two authors onto a standard form. Risk ratio (RR) for dichotomous data and a mean difference (MD) for continuous data were calculated with 95% confidence intervals (CI).

Main results

Three trials (139 patients) were included. APD did not differ from CAPD with respect to mortality (RR 1.49, 95% CI 0.51 to 4.37), risk of peritonitis (RR 0.75, 95% CI 0.50 to 1.11), switching from original PD modality to a different dialysis modality (RR 0.50, 95% CI 0.25 to 1.02), hernias (RR 1.26, 95% interval 0.32 to 5.01), PD fluid leaks (RR 1.06, 95% CI 0.11 to 9.83), PD catheter removal (RR 0.64, 95% CI 0.27 to 1.48) or hospital admissions (RR 0.96, 95% CI 0.43 to 2.17). There was no difference between either PD modality with respect to residual renal function (MD -0.17, 95% CI -1.66 to 1.32). One study found that peritonitis rates and hospitalisation were significantly less in patients on APD when results were expressed as episodes/patient-year. Another study found that patients on APD had significantly more time for work, family and social activities.

Authors' conclusions

APD has not been shown to have significant advantages over CAPD in terms of important clinical outcomes. APD may however be considered advantageous in select group of patients such as in the younger PD population and those in employment or education due to its psychosocial advantages. There is a need for a RCT comparing CAPD with APD with sufficiently large patient numbers looking at important clinical outcomes including residual renal function, accompanied by an economic evaluation to clarify the relative clinical and cost-effectiveness of both modalities.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Continuous ambulatory peritoneal dialysis versus automated peritoneal dialysis for end-stage renal disease

Peritoneal dialysis (PD) can be performed either manually as in continuous ambulatory peritoneal dialysis (CAPD) or using mechanical devices as in automated PD (APD). The aim of this review was to compare the effectiveness of CAPD and APD. Only three small randomised controlled trials (RCTs) (139 patients) were identified after an extensive literature search, and we found no difference between CAPD and APD for clinically important outcomes. APD may however be considered advantageous in select group of patients such as in the younger PD population and those in employment or education due to its psychosocial advantages. These outcomes were only reported in one trial. Large, long-term RCTs are needed in this area.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

比較末期腎衰竭病人使用連續可攜帶式腹膜透析和全自動腹膜透析

腹膜透析可以用手動的方式 (連續可攜帶式腹膜透析) 或自動化機器協助 (全自動腹膜透析) 。全自動腹膜透析被認為有許多連續可攜帶式腹膜透析沒有的優點,例如腹膜炎的機率低、機器併發症低、較大的社會心理的接受度

目標

評估末期腎衰竭病人使用連續可攜帶式腹膜透析和全自動腹膜透析的效果比較

搜尋策略

我們搜尋MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Renal Group's specialised register 和 CINAHL等資料庫聯絡所有涵括的研究作者並篩選出找到的隨機對照試驗之參考文獻及相關的綜論 最近一次搜尋日期: 2006年五月

選擇標準

比較末期腎衰竭病人使用連續可攜帶式腹膜透析和全自動腹膜透析的隨機對照試驗

資料收集與分析

資料被二位研究者做成標準格式的摘要,另一位檢查之統計分析用隨機效果模式,表示二元資料的相對風險 (RR) 及表示連續性結果的平均差,都加以計算並用百分之九十五的信賴區間表示。

主要結論

有三個試驗 (139位病人) 涵括在內,全自動腹膜透析和連續可攜帶式腹膜透析在死亡率 (相對風險 1.49, 百分之九十五的信賴區間0.51到4.37) 、腹膜炎的機率 (相對風險 0.75, 百分之九十五的信賴區間0.5到1.11) 、腹膜透析轉換成其他透析的比率 (相對風險 0.5, 百分之九十五的信賴區間0.25到1.02) 、疝氣 (相對風險 1.26, 百分之九十五的信賴區間0.32到5.01) 、腹膜透析液滲漏 (相對風險 1.06, 百分之九十五的信賴區間0.11到9.83) 、導管移除 (相對風險 0.64, 百分之九十五的信賴區間0.27到1.48) 、及住院率 (相對風險 0.96, 百分之九十五的信賴區間0.43到2.17) 並沒有差異。二種腹膜透析在殘餘腎功能上也沒有差異 (平均差 −0.17, 百分之九十五的信賴區間 −1.66到1.32) 。有一篇研究發現腹膜炎和住院率在使用全自動腹膜透析病人統計學上明顯較低。另一篇顯示使用全自動腹膜透析的病人有較多時間工作或從事家庭、社會活動

作者結論

在一些重要的臨床結果上,全自動腹膜透析比起連續可攜帶式腹膜透析並未有明顯好處。全自動腹膜透析因其社會心理的優點,也許在某些特定族群有好處,例如年輕族群、有工作及受教育族群。仍須要一個足夠病人數的大型隨機對照試驗來比較全自動腹膜透析和連續可攜帶式腹膜透析在一些臨床的重要結果上,包括殘餘腎功能和臨床及經濟效益

翻譯人

本摘要由馬偕醫院郭馨仁翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

腹膜透析可以用手動的方式 (連續可攜帶式腹膜透析) 或自動化機器協助 (全自動腹膜透析) 。本篇綜論的目的在比較二者的功效。在大範圍的文獻搜尋後,只有三個小型的隨機對照試驗 (139位病人) 涵括在內。我們發現在一些重要的臨床結果上,全自動腹膜透析比起連續可攜帶式腹膜透析並未有明顯差異。全自動腹膜透析因其社會心理的優點,也許在某些特定族群有好處,例如年輕族群、有工作及受教育族群。這些結果只有一篇試驗報導。此議題仍需要更大型長期的隨機對照試驗。