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The purpose of this work is to compare survival and drop-out in 2 groups of patients undergoing either CAPD (42 pts) or standard HD (48 pts) as first treatment, from November 1981 to December 1988. Mean age and number of risk factors were not significantly different. At the end of the study 50.0% of pts on CAPD and 37.5% on HD were still on first treatment; clinical problems were the most frequent cause of drop-out. The total period of observation was significantly higher in the CAPD group (1391.0 months vs 850.4), but the life table analysis showed no significant differences in the incidence of death and of drop-out in the two groups. The follow-up of the CAPD group was subdivided into two periods, due to the fact that a scheme for clinical and social survey of patients undergoing dialysis and a policy of more frequent home visits were introduced at the end of 1985. A significant decrease of peritonitis episodes was observed in the second period.

Among 63 patients (pts) on HPD 26 (41.7%) had need of a partner (PN) in conducting dialysis. In most cases the role of a partner is performed by the consort (26.9%) or by a son or daughter (19.3%). Forty-four percent of all partners worked in the home. The PN is significantly higher (P = 0.0001) in pts aged 65 or more. The most frequent cause of PN (38.6%) was a memory and learning deficiency (MLD) of the exact sequence of dialysis maneuvers, in particular in elderly pts. The Talking Cricket (TC), a tape recorder device with a series of automated and safety features, conceived and settled in our center to guide the patient through the dialysis procedures at home, represents a valid alternative choice to the partner in pts with MLD. Seven pts with MLD, aged between 69 and 80 years, used the TC at home with a Y-set with Amuchina. During a follow-up of 84.4 months we observed 3 peritonitis episodes, 4 accidental infusions of disinfectant in to the peritoneal cavity; and 3 pts discontinued the use of the TC. The TC has been used in the hospital to train 5 pts undergoing CAPD: standardization and uniformity of teaching facilitates both learning by the patients and teaching by the nurses.