Blood pressure behavior along the study period.

<p>Legend: Markers represent mean systolic and diastolic blood pressure whilst error bars represents confidence interval 95%. The bottom box indicates the absolute number of patients included in the analysis per group.</p

Automated Peritoneal Dialysis Is Associated with Better Survival Rates Compared to Continuous Ambulatory Peritoneal Dialysis: A Propensity Score Matching Analysis

<div><p>Introduction</p><p>The impact of peritoneal dialysis modality on patient survival and peritonitis rates is not fully understood, and no large-scale randomized clinical trial (RCT) is available. In the absence of a RCT, the use of an advanced matching procedure to reduce selection bias in large cohort studies may be the best approach. The aim of this study is to compare automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) according to peritonitis risk, technique failure and patient survival in a large nation-wide PD cohort</p><p>Methods</p><p>This is a prospective cohort study that included all incident PD patients with at least 90 days of PD recruited in the BRAZPD study. All patients who were treated exclusively with either APD or CAPD were matched for 15 different covariates using a propensity score calculated with the nearest neighbor method. Clinical outcomes analyzed were overall mortality, technique failure and time to first peritonitis. For all analysis we also adjusted the curves for the presence of competing risks with the Fine and Gray analysis.</p><p>Results</p><p>After the matching procedure, 2,890 patients were included in the analysis (1,445 in each group). Baseline characteristics were similar for all covariates including: age, diabetes, BMI, Center-experience, coronary artery disease, cancer, literacy, hypertension, race, previous HD, gender, pre-dialysis care, family income, peripheral artery disease and year of starting PD. Mortality rate was higher in CAPD patients (SHR1.44 CI95%1.21-1.71) compared to APD, but no difference was observed for technique failure (SHR0.83 CI95%0.69-1.02) nor for time till the first peritonitis episode (SHR0.96 CI95%0.93-1.11).</p><p>Conclusion</p><p>In the first large PD cohort study with groups balanced for several covariates using propensity score matching, PD modality was not associated with differences in neither time to first peritonitis nor in technique failure. Nevertheless, patient survival was significantly better in APD patients.</p></div

Determinants of Clinical Outcomes taking CAPD as the reference.

<p>CAPD: Continuous Ambulatory Peritoneal Dialysis; CI95% Confidence Interval 95%.</p><p>Determinants of Clinical Outcomes taking CAPD as the reference.</p

Standardized differences of means between covariates before and after match.

<p>Standardized differences of means between covariates before and after match.</p

Study Population.

<p>Study Population.</p

Clinical and demographic characteristics of matched patients.

<p>* In 2006 one Brazilian minimum wage was equivalent to 128US$and in 2010 raised to 325US$.</p><p>Clinical and demographic characteristics of matched patients.</p

Systolic (SBP), Diastolic (DBP) and Mean Arterial Pressures (MAP) in incident PD patients during 12 months of follow up.

<p>Systolic (SBP), Diastolic (DBP) and Mean Arterial Pressures (MAP) in incident PD patients during 12 months of follow up.</p

The increase in blood pressure levels correlates positively to the number of patients with edema.

<p>The increase in blood pressure levels correlates positively to the number of patients with edema.</p

Demographic, clinical and laboratory characteristics of patients at the baseline evaluation.

<p>NCA, number of classes of anti-hypertensives in use;</p>*<p>(E−) <i>vs</i> (E+);</p><p>SAP: systolic arterial pressure; DAP: diastolic arterial pressure;</p><p>MAP: mean arterial pressure.</p

Twelve-month evolution of the body mass index (BMI) in the patient cohort.

<p>Twelve-month evolution of the body mass index (BMI) in the patient cohort.</p