Comparison of Quality of Life on Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis
Comparison of Quality of Life on Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis
The objective of this study is to compare Quality of Life (QoL) between Automated Peritoneal
 Dialysis (APD) and Continuous Ambulatory Peritoneal Dialysis (CAPD).
Automated peritoneal dialysis (APD) was first described in 1981, 5 years after the
 introduction of continuous ambulatory peritoneal dialysis (CAPD). It is increasingly used
 increasingly used in comparison with CAPD from 20% in 1995 to more than 33% of PD patients in
 North America in 1998, and in 2000, 54% of PD patients in the United States performed some
 form of APD.

 APD has been several advantages over CAPD such as reduced incidence of peritonitis,
 mechanical complications and greater psychosocial acceptability. Many studies demonstrated a
 benefit for APD. In one Mexican retrospective study, APD has a better technical survival than
 CAPD with improvement of 1st peritonitis episode and French registry data showed the better
 peritonitis-free probability and autonomy in APD compared to CAPD. One study found that
 peritonitis rates and hospitalization were significantly less in patients on APD when results
 were expressed as episode/patient-year. Also a small randomized clinical trial comparing APD
 and CAPD showed that APD can help to keep selected patients vocationally or socially active.

 Although APD has been expected to improve better condition of peritoneal dialysis patients,
 convincing evidence of major advantages is lacking and a benefit for APD is not demonstrated.

 In three of randomized clinical trials, APD, 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% CI 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 (RR0.96, 95% CI
 0.43 to 2.17). In addition APD has potential disadvantages compared with CAPD like a possible
 faster in residual renal function, less sodium removal and more peritoneal protein loss and
 more expensive than CAPD. All of three large cohorts, NECOSAD, USRDS and ANZDATA showed that
 the risk of technical failure was not different between APD and CAPD but similar.

 Because results on comparison between APD and CAPD is vague, prospective, observational and
 multi-center study in incident patients are required to gain more insight into survival on
 APD compared with CAPD in the course of peritoneal dialysis.

 Quality of Life is an important outcome parameter when advising patients on renal replace
 treatment modality section. The introduction of a machine to assist the patient with PD
 exchanges can potentially improve quality of life in different ways. De Wit et al. analyzed
 health-related quality of life (HRQOL) in 37 APD and 59 CAPD patients from 16 different Dutch
 dialysis centers. In a multivariate analysis, the mental health was found to be better in APD
 as compared to CAPD patients. In addition, there were indications that APD patient tended to
 be less depressed and anxious than CAPD patients. In a prospective randomized trial, Bro et
 al. found no difference between CAPD and APD patients in quality of life measures. However
 APD patient tended to have more time for work, family, and social activities as compared to
 CAPD patients.

 From these limited data, it can possibly be concluded that quality of life is very important
 to evaluate the lifestyle of the patient and to adapt the PD regimen.

 Therefore, quality of life (QoL) assessment is expected to evidence to support the hypothesis
 that APD is superior to CAPD.

 And the incidences of clinical events treatment modality change, peritonitis episode, exit
 site/tunnel infection, hospitalization, death, cancer development) are also reviewed to
 support that hypothesis.
Inclusion Criteria:

 -  Male or female subjects at least 20 and older at that time of obtaining informed
 consent

 -  Subjects performing CAPD or APD

 -  Subject with a total Kt/V≥ 1.7 at baseline

 Exclusion Criteria:

 -  Subjects who have undergone abdominal surgery within the last 30 days except for PD
 catheter insertion

 -  Subjects who is planned for renal transplantation or hemodialysis within 1 year
 following the date of informed consent

 -  Subjects who have received antibiotics for the treatment of peritonitis, exit-site or
 tunnel infection within the last 30 days

 -  Subjects who have active liver disease such as cirrhosis of the liver, active
 hepatitis or other active liver disease as evidenced by biopsy, laboratory (unstable
 liver enzymes over the last 90 days) or clinical examination.