Outcome of patients treated with automated peritoneal dialysis : effects of selection of patients

Abstract EN

To determine the effect of selection of peritoneal dialysis patients who used automated PD (APD) as a first renal replacement therapy (RRT) option, we studied two groups of adult chronic kidney disease (CKD) patients treated with APD over a period of 4 years: group 1 included 30 patients in whom APD was the first choice for RRT and group 2 included 40 patients transferred from failed hemodialysis (HD) treatment.

Both groups were matched for the original causes of CKD and comorbid conditions.

However, group 1 had significantly higher residual renal function (RRF) than group 2 [glomerular filtration rate (GFR) 11.85 ± 4 mL/min and urine output 995 ± 465 mL/day vs.

3.69 ± 3.7 mL/min and 340 ± 447 mL/day, respectively, P = 0.0001] and Kt/v (2.7 ± 0.7 vs.

1.9 ± 0.4, respectively, P = 0.006).

Most of the patients were compliant with their APD prescription, performed ideal PD techniques, achieved adequate dialysis and fluid ultrafiltration, and experienced much less than average infectious and non-infectious complications.

However, group 1 achieved better clinical outcome than group 2, including relatively higher survival rate and kidney transplantation, significantly fewer episodes of peritonitis per year (0.09 vs.

0.14, respectively, P = 0.0001), higher serum albumin (2.95 ± 0.3 vs.

2.7 ± 0.27 g/dL, respectively, P = 0.035), hemoglobin (11.5 ± 0.9 vs.

10.6 ± 0.7 g/dL, respectively, P = 0.022) and lower parathormone levels (283 ± 117 vs.

389 ± 269 pg/mL, respectively, P = 0.02).

They also maintained significantly higher total fluid removal compared to group 2 (1120 ± 330 vs.

560 ± 300 mL/day, respectively, P = 0.004), higher RRF (GFR 8 ± 2.6 mL/min vs.

1.8 ± 2.4 mL/min, respectively, P = 0.0001), and urine output (556 ± 447 mL/day vs.

240 ± 347 mL/day, respectively, P = 0.004), and significantly higher Kt/v (2.8 ± 0.7 vs.

1.9 ± 0.4, respectively, P = 0.2).

In conclusion, in CKD patients, PD is a viable initial modality of RRT, and with better RRF may have a better outcome than as a secondary choice.