Long-term CAPD survival and analysis of mortality risk factors: 12-year experience of a single Mexican center.

OBJECTIVE: To evaluate patient and technique survival, and to analyze mortality risk factors in a large Mexican single-center continuous ambulatory peritoneal dialysis (CAPD) program.
DESIGN: Cohort study.
SETTING: Tertiary care, teaching hospital located in Mexico City. PATIENTS: All patients from our CAPD program (1985-1997) were retrospectively studied.
INTERVENTIONS: Clinical and biochemical variables at the start of dialysis were recorded and considered in the analysis of risk factors. MAIN OUTCOME MEASURES: End points were patient (alive, dead, or lost to follow-up) and technique status at the end of the study (December 1997).
RESULTS: 627 patients, 37% with diabetes mellitus (DM), were included. Median patient survival (+/- SE) was 5.1 +/- 0.6 years. In the univariate analysis, the following variables were associated (p < 0.05) with mortality: DM, old age, hypoalbuminemia, low serum creatinine, low serum phosphate, and lymphopenia. In the multivariate analysis, the only significant mortality risk factors were DM (RR 2.56, p < 0.0001), old age (RR 1.01, p = 0.01), hypoalbuminemia (RR 0.77, p = 0.04), and lymphopenia (RR 0.98, p = 0.05). Median technique survival was 4.0 +/- 0.2 years. Peritonitis, hypoalbuminemia, lymphopenia, old age, and DM were all significantly associated (p < 0.05) with technique failure in the univariate analysis, while in the multivariate analysis, only DM (RR 1.78, p = 0.001), peritonitis (RR 1.13, p = 0.004), lymphopenia (0.98, p = 0.04), and hypoalbuminemia (RR 0.80, p = 0.06) were technique failure predictors.
CONCLUSIONS: Patient survival in our setting is similar to that reported in other series. Diabetes mellitus, lymphopenia, and hypoalbuminemia were the strongest predictive factors for mortality and technique failure on CAPD. Our 12-year CAPD program is one of the largest single-centers reported in CAPD literature.