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      Rapid Initiation of Peritoneal Dialysis by Automated Peritoneal Dialysis or Hemodialysis: A Randomized Clinical Trial

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          Abstract

          Introduction

          It is still controversial whether automated peritoneal dialysis (APD) or hemodialysis (HD) is a more favorable choice for the rapid initiation of peritoneal dialysis (PD).

          Methods

          A pilot randomized prospective controlled trial was carried out in Shanghai Ruijin Hospital. Sixty-seven patients who chose long-term PD treatment and needed unplanned dialysis were enrolled and randomized into HD-CAPD group (33 cases) or APD-CAPD group (34 cases) based on the dialysis modality during the transition period (within 14 days from the day PD catheter was implanted). Continuous ambulatory PD started after the transition period. The primary outcome was the decline rates of residual glomerular filtration rate (GFR). Secondary outcomes included the rates of mechanical complications, the rates of infectious complications, and complications of end-stage renal disease.

          Results

          We found residual GFR decline was faster in HD-CAPD group than in APD-CAPD group (0.06 mL/min/w vs. 0.03 mL/min/w, p < 0.01). The incidences of mechanical complications were similar in APD-CAPD group comparing with HD-CAPD group, including hernia (2.9% vs. 3.0%, p = 1.00), catheter malposition (0.02 episodes/patient-months vs. 0.02 episodes/patient-months, p = 0.70), leakage (5.9% vs. 6.1%, p = 1.00), and omental wrap (0 episode vs. 3 episodes, p = 0.368). Though the 1-year overall infection rates were similar (0.03 episodes/patient-months vs. 0.05 episodes/patient-months, p = 0.10), APD-CAPD group had lower rate of bacteremia compared to HD-CAPD group (0 episodes/patient-months vs. 0.02 episodes/patient-months, p < 0.01).

          Conclusions

          Both APD and HD could be used for patients who need to start dialysis in an unplanned manner. APD may have the advantage in protecting residual renal functions among these patients.

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          Most cited references27

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          US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States

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            Predictors of loss of residual renal function among new dialysis patients.

            Residual renal function (RRF) in end-stage renal disease is clinically important as it contributes to adequacy of dialysis, quality of life, and mortality. This study was conducted to determine the predictors of RRF loss in a national random sample of patients initiating hemodialysis and peritoneal dialysis. The study controlled for baseline variables and included major predictors. The end point was loss of RRF, defined as a urine volume <200 ml/24 h at approximately 1 yr of follow-up. The adjusted odds ratios (AOR) and P values associated with each of the demographic, clinical, laboratory, and treatment parameters were estimated using an "adjusted" univariate analysis. Significant variables (P < 0.05) were included in a multivariate logistic regression model. Predictors of RRF loss were female gender (AOR = 1.45; P < 0.001), non-white race (AOR = 1.57; P = <0.001), prior history of diabetes (AOR = 1.82; P = 0.006), prior history of congestive heart failure (AOR = 1.32; P = 0.03), and time to follow-up (AOR = 1.06 per month; P = 0.03). Patients treated with peritoneal dialysis had a 65% lower risk of RRF loss than those on hemodialysis (AOR = 0.35; P < 0.001). Higher serum calcium (AOR = 0.81 per mg/dl; P = 0.05), use of an angiotensin-converting enzyme inhibitor (AOR = 0.68; P < 0.001). and use of a calcium channel blocker (AOR = 0.77; P = 0.01) were independently associated with decreased risk of RRF loss. The observations of demographic groups at risk and potentially modifiable factors and therapies have generated testable hypotheses regarding therapies that may preserve RRF among end-stage renal disease patients.
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              Predictors of the rate of decline of residual renal function in incident dialysis patients.

              Residual renal function (RRF) influences morbidity, mortality and quality of life in chronic dialysis patients. Few studies have been published on risk factors for loss of RRF in dialysis patients. These studies were either retrospective, performed in a small number of patients, or estimated GFR without a urine collection. We analyzed the decline rates of residual GFR (rGFR) prospectively in 522 incident HD and PD patients who had structured follow-up assessments. GFR was measured as the mean of urea and creatinine clearance, calculated from urine collections. The initial value was obtained 0 to 4 weeks before the start of dialysis. The measurements were repeated 3, 6, and 12 months after the start of dialysis treatment. After logarithmic transformation, differences in rGFR changes over time were analyzed using repeated measurement analysis of variance. Baseline factors that were negatively associated with rGFR at 12 months were a higher diastolic blood pressure (P < 0.001) and a higher urinary protein loss (P < 0.001). Primary kidney disease did not affect rGFR. Averaged over time, PD patients had a higher rGFR (P < 0.001) than HD patients. This relative difference increased over time (P = 0.04). Investigation of possible effects of the dialysis procedure on the decline rate between 0 and three months showed that dialysis hypotension (P = 0.02) contributed to the decline in HD and the presence of episodes with dehydration contributed in PD (P = 0.004). rGFR is better maintained in PD patients than in HD patients. The associated factors such as a higher diastolic blood pressure, proteinuria, dialysis hypotension and dehydration can either be treated or avoided.
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                Author and article information

                Journal
                Kidney Dis (Basel)
                Kidney Dis (Basel)
                KDD
                KDD
                Kidney Diseases
                S. Karger AG (Basel, Switzerland )
                2296-9381
                2296-9357
                6 October 2023
                December 2023
                : 9
                : 6
                : 529-537
                Affiliations
                [1]Department of Nephrology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China
                Author notes
                Correspondence to: Hong Ren, renhong66@ 123456126.com or Jingyuan Xie, nephroxie@ 123456163.com

                Qianying Zhang and Pei Wu contributed equally to this work.

                Hong Ren and Jingyuan Xie are the co-corresponding authors.

                Article
                534334
                10.1159/000534334
                10712965
                38089438
                d90e695f-a7e9-47e9-9961-fd537842a15a
                © 2023 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                : 31 May 2022
                : 18 September 2023
                : 2023
                Page count
                Figures: 2, Tables: 2, References: 27, Pages: 9
                Funding
                This study was supported by a grant from Baxter Healthcare.
                Categories
                Research Article

                unplanned dialysis initiation,transitional period,automated peritoneal dialysis

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