Peritoneal dialysis versus hemodialysis: a five-year comparison of survival and effects on the cardiovascular system, erythropoiesis, and calcium metabolism.

The influence that the mode of dialysis has on the prognosis of patients with renal disease is controversial. The controversy arises at least in part because of the heterogeneity of patient populations, who may be receiving either continuous ambulatory peritoneal dialysis (CAPD) or hemodialysis (HD). In the absence of randomized trials, epidemiologic investigations present the best method for studying the problem. To determine the influence of the mode of dialysis on prognosis and on the cardiovascular system, erythropoiesis, and calcium metabolism, we selected 36 patients undergoing CAPD and 36 patients undergoing HD for a 3-year follow-up study. Patients were matched for age, sex, and cause of renal disease. Among the HD patients, 8 deaths occurred from congestive heart failure, 1 death from cerebrovascular accident, and 2 deaths from severe infection. In the HD group, the average age was 63 +/- 3 years. Among the CAPD patients, 6 were transferred to HD because of recurrent peritonitis or elevation of serum creatinine. Patients on CAPD had lower blood pressures, and patients on HD had lower total cholesterol levels. Other parameters were not significantly different between the two groups, including dose of erythropoietin and calcium supplements administered. Our study provides evidence that clinical outcome in renal failure may depend to some extent on the mode of dialysis. Our results suggest that blood pressure level and serum cholesterol should be taken into account for patients treated with either CAPD or HD. Blood pressure and cholesterol level are both likely to be important contributors to mortality and morbidity in renal patients.