Insufficient evidence from trials comparing CAPD (home dialysis without a machine) with hospital dialysis for people with kidney failure

Vale L, Cody JD, Wallace SA, Daly C, Campbell MK, Grant A, Khan I, MacLeod AM

Published Online:

July 8, 2009

When people's kidneys fail (end-stage renal disease), they need either a transplant or dialysis to keep performing the kidney's functions. Dialysis can involve either regular visits to hospital for time on an artificial kidney machine (haemodialysis), or home dialysis. Home dialysis (CAPD - continuous ambulatory peritoneal dialysis) is a 'do it yourself' option that does not require a machine. It involves a tube permanently inserted through the abdomen to allow a fluid called dialysate to be emptied and replaced every day. The review found only one trial comparing the effects of CAPD and haemodialysis. No conclusions could be drawn.

Abstract (click to read)

Background:

Renal replacement therapy (RRT) with dialysis and transplantation is the only means of sustaining life for patients with end-stage renal disease (ESRD). Although transplantation is the treatment of choice, the number of donor kidneys are limited and transplants may fail. Hence many patients require long-term or even life-long dialysis. Continuous ambulatory peritoneal dialysis (CAPD) is an alternative to hospital or home haemodialysis for patients with ESRD.

Objectives:

To assess the benefits and harms of CAPD versus hospital or home haemodialysis for adults with ESRD.

Search strategy:

We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), the Cochrane Renal Group's specialised register, MEDLINE (1966 - May 2002), EMBASE (1980 - May 2002), BIOSIS, CINAHL, SIGLE and NRR without language restriction. Reference lists of retrieved articles and conference proceedings were searched and known investigators and biomedical companies were contacted. Date of most recent search January 2004.

Selection criteria:

Randomised controlled trials (RCTs) or quasi-RCTs comparing CAPD to hospital or home haemodialysis for adults with ESRD were to be included.

Data collection and analysis:

Two reviewers independently assess the methodological quality of studies. Data was abstracted from included studies onto a standard form by one reviewer and checked by another. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CI).

Main results:

One trial, reported in abstract form only, was located in the most recent search. There was no statistical difference in death or quality adjusted life years score at 2 years between peritoneal dialysis or haemodialysis patients.

Authors' conclusions:

There is Insufficient data to allow conclusions to be drawn about the relative effectiveness of CAPD compared with hospital or home haemodialysis for adults with ESRD. Efforts should be made to start and complete adequately powered RCTs, which compare the different dialysis modalities.

This record should be cited as:

Vale L, Cody JD, Wallace SA, Daly C, Campbell MK, Grant A, Khan I, MacLeod AM. Continuous ambulatory peritoneal dialysis (CAPD) versus hospital or home haemodialysis for end-stage renal disease in adults. Cochrane Database of Systematic Reviews 2004, Issue 4. Art. No.: CD003963. DOI: 10.1002/14651858.CD003963.pub2

Assessed as up to date:

February 5, 2008

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Primary Review Group:

Renal Group

Health topics:

Kidney disease > End-stage kidney disease > Peritoneal dialysis

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Insufficient evidence from trials comparing CAPD (home dialysis without a machine) with hospital dialysis for people with kidney failure

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