Comparison of Quality of Life on Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis

NCT ID: NCT01209273

Last Updated: 2015-09-15

Basic Information

• Recruitment Status: COMPLETED
• Total Enrollment: 260 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2010-10-31
• Study Completion Date: 2015-09-30

Brief Summary

The objective of this study is to compare Quality of Life (QoL) between Automated Peritoneal Dialysis (APD) and Continuous Ambulatory Peritoneal Dialysis (CAPD).

Detailed Description

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.

Conditions

End Stage Renal Disease; Peritoneal Dialysis

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

APD group

which can be 3 to 5 exchanges daily, and up to 20 liters daily( including up to two daytime exchanges)

No interventions assigned to this group

CAPD group

which can be 1 to 4 exchanges daily and up to 16 liters daily(including up to two daytime exchanges)

No interventions assigned to this group

Eligibility Criteria

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.

• Minimum Eligible Age: 20 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Clinical Research Center for End Stage Renal Disease, Korea

OTHER

Sponsor Role: collaborator

Baxter Healthcare Corporation

INDUSTRY

Sponsor Role: collaborator

Kyungpook National University Hospital

OTHER

Sponsor Role: lead

Responsible Party

Yong-Lim Kim

Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Yong-Lim Kim, M.D., Ph.D.

Role: PRINCIPAL_INVESTIGATOR

Division of Nephrology, Department of Internal Medicine, Kyungpook National University School of Medicine

Locations

Daegu Fatima Hospital

Daegu, , South Korea

Eulji University Hospital

Daejeon, , South Korea

Chosun University Hospital

Gwangju, , South Korea

Jeju National University Hospital

Jeju City, , South Korea

Korea University Anam Hospital

Seoul, , South Korea

Eulji General Hospital

Seoul, , South Korea

St. Carolo Hospital

Suncheon, , South Korea

Inje University Haeundae Paik Hospital

Busan, , South Korea

Samsung Changwon Hospital

Changwon, , South Korea

Chungbuk National University Hospital

Cheongju-si, , South Korea

Kyungpook National University Hospital

Daegu, , South Korea

Countries

South Korea

Other Identifiers

A-01

Identifier Type: -

Identifier Source: org_study_id