Is CAPD competitive with haemodialysis for long-term treatment of uraemic patients?

Although there are only 10 years of clinical experience with CAPD, compared to about 30 years of clinical practice with haemodialysis, it is time to compare the results obtained from the two methods. In this review, after briefly summarising the state of the art for some worrisome aspects of CAPD (peritonitis, loss of ultrafiltration and peritoneal clearance, malnutritional status), the ability of CAPD and haemodialysis to control the uraemic abnormalities are compared. Anaemia, blood pressure, cardiac function, renal bone disease, beta 2-microglobulin, and uraemic neuropathy are examined in the light of our personal experience and the literature; data so far published seem to indicate that the two methods are roughly similar for controlling these conditions. A survey of the studies comparing patient and method survival is also included. Patient survival on CAPD or on haemodialysis does not differ by more than 6 years. Method survival is better for haemodialysis; this is primarily due to the high drop-out rate from CAPD because of peritonitis, and the difference is very much reduced in CAPD centres with a low incidence of peritonitis. On the whole, CAPD seems to be able to compete, sometimes favourably, with haemodialysis. However, in our opinion the two methods are not in competition; each has its preferential indications, limits and complications, and both should be offered to uraemic patients in accordance with their medical or social needs. One should be ready to shift the patient from one method to the other when necessary, either for short periods of time or indefinitely.