Comparisons of patient and technique survival were made for 120 CAPD and 139 HD patients undergoing dialysis between January 1981 and December 1986. Cox's proportional hazard regression model was used to compare patient and technique survival, with an adjustment for pre-treatment prognostic differences. Only the patients' first treatments were considered. The CAPD patients were 10 years older, on the average, than the HD patients and had more complicated conditions (58% with 3 or more co-existing risk factors vs. 35%). Overall patient survival between CAPD and HD did not differ (P = 0.2694). However, when adjusted for patient age, sex and other comorbid complicating conditions, CAPD patients over the age of 66 had a significantly lower risk of death than their HD counterparts (P less than 0.05). There were no differences in the adjusted patient survival for patients aged 30 to 66. Four pre-treatment prognostic factors had statistically significant adverse effects on patient survival: age, diabetes, malignancy and peripheral vascular disease. Survival of the HD technique, when unadjusted, was better than survival of CAPD (P = 0.0457). Even after adjustment for sex and age, this difference was still very nearly significant (P = 0.0656). No risk factors were found to be significantly associated with technique survival. Based on patient and technique survival, CAPD would appear to be an excellent alternative to HD and may be the preferred treatment for high risk patients over the age of 66.

Four hundred and eighty CAPD and 373 HD patients started regular dialysis treatment between 1981 and 1987 in 6 dialysis centers. The CAPD patients were 6 years older, on average, than the HD patients and had more complicating conditions (43.3% with 3 or more coexisting risk factors versus 28.9% with coexisting complications). The 7-year patient survival rate was not significantly different. Cox's proportional hazards regression showed that age, cardiovascular disease, cerebrovasculardisease, peripheral vasculardisease, diabetes, malignancy and multisystem disease had significant adverse effects on patient survival. After correcting for the influence of these factors, no significant differences in patient survival were seen. However, after 53.5 years of age, the increase in the risk of death was significantly higher in HD than in CAPD patients. Technique survival was significantly different in the 6 centers and was better for HD than for CAPD. There was no statistically significant difference between CAPD and HD technique survival when peritonitis was eliminated as a cause of failure. Based on this 7 year analysis, CAPD would appear to be an excellent alternative to HD.

This prospective cross-over study was undertaken to evaluate the safety and efficacy of a 1% amino acid dialysis solution on the nutritional and metabolic changes, plasma amino acid profiles and peritoneal membrane function of patients on CAPD. Six CAPD patients had one exchange a day with two liters of this solution over a six month period. Every month there was a medical examination, anthropometric measurements and dietary inquiry were made, blood biochemistry tests were done. Every three months renal function, peritoneal function, aminograms of plasma and dialysate and nitrogen balance were determined. Data were compared with those obtained one month prior to and three months after withdrawal of amino acid administration. Nitrogen balance, which was negative (-1.3 g/day) became positive (+3.1 g/day). Patients who were already overweight increased in weight, both in fat and lean mass. Plasma cholesterol and triglycerides significantly decreased and the amino acid profile moved towards normal; plasma urea levels increased and pH and bicarbonate decreased slightly but significantly (P less than 0.05). Plasma protein concentrations did not change. All the above parameters turned towards basal values when amino acids were discontinued. We conclude that amino acids can be used as osmotic agents for CAPD since they do not cause toxic effects or impair peritoneal membrane function. Moreover, they can help the nutritional status, provided that an increase in weight is prevented and the slight worsening of systemic acidosis is corrected.

The study involved eight metabolically stable children, with chronic renal failure on continuous ambulatory peritoneal dialysis (CAPD) whom we followed for 12-18 months. For the first 6 months CAPD was performed with dextrose; for the subsequent 6-12 months the morning exchange was substituted with a 1% amino-acid (AA) solution. The following parameters did not change during the study: serum creatinine, uric acid, inorganic phosphate, serum bicarbonate, potassium, cholesterol, triglycerides, total protein, albumin and transferrin. The only parameter that changed was blood urea nitrogen, which increased moderately. The anthropometric parameters did not show significant variation before and after AA dialysis. The plasma AA profile, which under basal conditions showed lower levels of several essential AAs, improved during the treatment period, with a partial correction of the imbalance. It is possible that this correction of plasma AAs may positively influence the metabolism of some organs such as the brain, muscle and those of the hepatosplanchnic region. The intracellular pool of free AAs, measured in polymorphonuclear leucocytes, was severely altered before the treatment and after 6 and 12 months showed only minor variations. It is possible that some modifications in the proportion of the different AAs in the dialysis solution or an improvement in the concentration or in the number of exchanges per day are necessary in order to change the nutritional status and to modify the intracellular AA pool.

Plasma cholesterol, triglyceride, lipoprotein and phospholipid levels were higher in 76 transplant recipients than in normal age-matched controls. 22 patients exhibited a normal lipid pattern; 12 a type IIa, 12 a type lib, and 30 a type IV hyperlipidemia. Lipid abnormalities were not related to serum creatinine, parathyroid hormone (PTH), serum albumin, plasma glucose, transplant age, relative body weight or steroid administration schedule. Only plasma triglyceride level was related to mean prednisone dosage. In order to reduce the apparent cardiovascular risk posed by these changes in plasma lipid concentration, hypocaloric diet was administered to 16 patients with hypertriglyceridemia or mixed hypertriglyceridemia and hypercholesterolemia. With these dietary measures, plasma lipid concentrations returned to normal and remained stable during the period of observation (6–18 months).