1. Renal Medicine David Johnson Princess Alexandra Hospital Brisbane, Australia A Comparison of APD vs CAPD on Patient Outcomes A Comparison of APD vs CAPD on Patient Outcomes Badve S, Hawley CM, Mudge DW, Rosman JB, Brown FG, Johnson DW

2. ? CAPDAPD

3. APD vs CAPD Use in Australia 5% 7% 11% 14% Number 22% 27% 33% 39% 41% 43%

4. APD Use: USA vs Aust vs UK

6. Traditional APD Indications  Enhance small solute clearances  Enhance ultrafiltration (esp high transport)  Social reasons –Employment –School –Care of elderly/debilitated patients  Mechanical problems –Hernias, leaks, back pain, body image  Reduce peritonitis rates

7. Rabindranath NDT (In press) N=139

8. Ultrafiltration: APD vs CAPD P=NS N=25 Bro et al Perit Dial Int 19:526-33,1999 CAPDAPD

9. QOL: APD vs CAPD Bro et al Perit Dial Int 19:526-33,1999

11. RRF Loss: APD vs CAPD Hufnagel et al Nephrol Dial Transplant 14:1224-8, 1999 ** * p<0.05 n=36

12. US Study SurvivalTechnique Survival HRP P Age1.04<0.00011.007<0.0001 PD 1 st 0.725<0.00010.789<0.0001 Diabetes0.701<0.00010.852<0.0001 Centre0.94<0.0001 APD0.845<0.0001 Mujais and Story Kidney Int 70:S21-6, 2006

13. USA

14. Aim  To compare patient survival and death- censored technique survival in patients treated with APD vs CAPD using ANZDATA

15. Methods  All ANZ patients starting PD between April 1, 1999 and March 31, 2004  Complete follow-up  1° outcomes death and death-censored technique failure  Survival time calculated from date of commencement of each PD episode to the date of death, transfer to hemodialysis, transplantation, loss of follow up, or March 31, 2004.

16. Statistics  Kaplan-Meier and multivariate Cox proportional hazards model analyses  PD modality included as a time-dependent covariate  Analyses stratified according to initial or subsequent episodes of PD  Used a conditional risk set model for multiple failure data  Standard errors calculated using robust variance estimation for the correlated data, clustered according to the centre of initial treatment

17. Baseline Characteristics

18. Patient Survival Badve et al Kidney Int (In press) N=4128 AHR 1.03 (95% CI 0.86-1.24) p=0.72

19. Death-Censored Technique Survival N=4128 AHR 1.08 (95% CI 0.91-1.27) p=0.38 Badve et al Kidney Int (In press)

20. Death-Censored Technique Survival after 1 st Failure Occurrence Badve et al Kidney Int (In press)

21. Propensity Score: Survival ModelHR95%CIP Unadjusted0.920.77 – 1.090.336 Adjusted1.030.86 – 1.240.723 Adjusted+PS0.840.68 – 1.030.09 Badve et al Kidney Int (In press)

22. PS: Death-Censored Technique Survival ModelHR95%CIP Unadjusted1.090.92 – 1.300.319 Adjusted1.080.91 – 1.270.381 Adjusted+PS1.070.91 – 1.270.381 Badve et al Kidney Int (In press)

23. Conclusions  APD results in similar patient survival and technique success rates compared to CAPD in 4,128 ANZ PD patients followed over 6,982 person-years  There is currently no strong clinical evidence, except for lifestyle considerations, for favouring APD over CAPD