Continuous ambulatory peritoneal dialysis and survival of HIV infected patients with end-stage renal disease

Abstract

As the number of human immuno-deficiency virus (HIV) infected patients has increased in the U.S., the number of infected patients treated for end-stage renal disease (ESRD) has stabilized at about 1 to 2% of the hemodialyzed population. Little has been written regarding the role of continuous ambulatory peritoneal dialysis (CAPD) in the treatment of HIV infected patients with ESRD. To evaluate the effectiveness of CAPD as a long term therapy for HIV infected patients with ESRD, we reviewed our ESRD program's experience. We entered 392 patients from its inception in February 1984 until April 1992. Thirty-one, or 7.9% of our population were HIV infected. Twenty, or 64.5% had stage IV infection. Patients were entered into our chronic hemodialysis (HD) or CAPD program according to standard clinical criteria. Eight HIV infected patients elected to start CAPD, while 23 patients were treated exclusively with HD. The proportion of stage IV infected patients was similar in both treatment modality groups. HIV infected ESRD patients were younger than non-HIV infected patients (37.5 ± 9.7 vs. 49.8 ± 15.7 years, respectively, P < 0.0001) at the start of treatment. We used Cox regression techniques to analyze survival data. Mean survival time for our entire non-HIV infected ESRD population (N = 361) was 44.0 ± 33.9 months. Mean survival time for HIV infected patients with ESRD was 15.5 ± 9.9 months. Median survival for HIV infected ESRD patients was 13 months compared to 38 months for the non-infected population. As expected, mean survival time in HIV infected ESRD patients was significantly diminished compared to non-infected ESRD patients (P < 0.0001). When HIV infected patients were analyzed separately, however, there was no difference in mean survival time between patients treated with HD and CAPD (14.7 ± 9.7 vs. 17.9 ± 10.7 months, respectively). Age, HIV status and stage of HIV infection were predictors of survival in ESRD patients, while sex and race were not. The peritonitis rate in HIV infected patients treated with CAPD was not different from that in non-HIV infected CAPD patients. The etiologic agents of peritonitis in the HIV-infected population were similar to those in non-infected populations. We conclude that HD and CAPD are equally good treatment alternatives for HIV infected patients with ESRD.