Automated vs continuous ambulatory peritoneal dialysis: a systematic review of randomized controlled trials

Background. A systematic review of randomized controlled trials (RCTs) comparing continuous ambulatory peritoneal dialysis (CAPD) with all forms of automated peritoneal dialysis (APD) was performed to assess their comparative clinical effectiveness. Methods. The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and CINAHL, were searched for relevant RCTs. Analysis was by a random effects model and results expressed as relative risk (RR) and weighted mean difference (WMD) with 95% confidence intervals (CI). Results. Three trials (139 patients) were identified. APD when compared to CAPD was found to have significantly lower peritonitis rates (two trials, 107 patients, rate ratio 0.54, 95% CI 0.35–0.83) and hospitalization rates (one trial, 82 patients, rate ratio 0.60, 95% CI 0.39–0.93) but not exit-site infection rates (two trials, 107 patients, rate ratio 1.00, 95% CI 0.56–1.76). However no differences were detected between APD and CAPD in respect to risk of mortality (RR 1.49, 95% CI 0.51–4.37), peritonitis (RR 0.75, 95% CI 0.50–1.11), switching from the original peritoneal dialysis (PD) modality to a different dialysis modality including an alternative form of PD (RR 0.50, 95% CI 0.25–1.02), PD catheter removal (RR 0.64, 95% CI 0.27–1.48) and hospital admissions (RR 0.96, 95% CI 0.43–2.17). Patients on APD were found to have significantly more time for work, family and social activities. Conclusions. APD appears to be more beneficial than CAPD, in terms of reducing peritonitis rates and with respect to certain social issues that impact on patients’ quality of life. Further, adequately powered trials are required to confirm the benefits for APD found in this review and detect differences with respect to other clinically important outcomes that may have been missed by the trials included in this review due to their small size and short follow-up periods.