Comparison of continuous ambulatory peritoneal dialysis and hemodialysis in children.

The clinical course of 51 children, 0.2 to 20 years, treated with CAPD, and 25 children, 3 to 18 years, treated with chronic hemodialysis was compared over a 5 1/2 year period. The CAPD patients had higher hematocrit levels, higher serum carbon dioxide and cholesterol levels, lower BUN and serum albumin levels, and lower blood pressure levels than the hemodialysis patients. Linear growth was better in the CAPD patients with one method of assessment, but not with another. Complications were more frequent in the CAPD patients; the peritonitis rate was one episode per 7.2 patient-months and there were 46 failures of peritoneal catheters compared with 12 failures of hemodialysis access. Five CAPD patients died and seven transferred to hemodialysis, whereas one hemodialysis patient died and four transferred to CAPD. Although some advantages of CAPD were demonstrated in this study, the high complication rate and unexpectedly high mortality rate observed with CAPD were disturbing and indicate the need for further evaluation of this form of therapy.