Comparisons of technique success by
peritoneal dialysis (PD) modality have typically excluded the initial 90 days of
therapy. We analyzed a database of 51,469 new PD starts from 2004 to 2008 in the United States. The analysis concentrated on the initial 90 days of
therapy to determine technique success and the impact of the continuous ambulatory PD (
CAPD) and automated PD (APD) modalities. Overall, 13.3% of patients stopped PD within 90 days. Of patients starting directly on APD, 14.3% stopped PD within 90 days. Of patients starting on
CAPD, 12.6% stopped PD within 90 days, and 63.4% changed to APD within 90 days. Only 3.3% of the latter patients failed to reach 90 days of
therapy. By comparison, technique failure occurred in 28.8% of those initiating with and remaining on
CAPD. We conclude that initial training to perform
CAPD, with timely transfer to APD within the first 3 months, was associated with the greatest technique success at 90 days. The reasons for that success are unclear, and further research should be directed to determining factors responsible. It is possible that patients trained initially to
CAPD but converted to APD have a greater understanding of the total
therapy, which improves confidence. Those converted to APD may be more appreciative of the lifestyle benefits of APD, which translates into improved compliance; alternatively, technical factors associated with APD may be responsible. Those technical factors may include improved
catheter function in the recumbent position during APD or the reduced
infection risk associated with just 2 connect/disconnect procedures in APD compared with 8 in
CAPD.