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

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 AP...

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Bibliographic Details
Published in:Saudi journal of kidney diseases and transplantation 2011, Vol.22 (1), p.40-48
Main Authors: Karkar, Ayman, Abd al-Rahman, Muhammad
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Analysis
Care and treatment
Chronic Disease
Chronic kidney failure
Continuous ambulatory peritoneal dialysis
Diseases
Female
Glomerular Filtration Rate
Health aspects
Humans
Kidney Diseases - physiopathology
Kidney Diseases - therapy
Kidneys
Male
Middle Aged
Outcome and Process Assessment (Health Care)
Patient Compliance
Patient outcomes
Patient Selection
Peritoneal dialysis
Peritoneal Dialysis - adverse effects
Peritonitis - etiology
Renal Dialysis - adverse effects
Saudi Arabia
Time Factors
Treatment Failure
Urodynamics
Young Adult
الأمراض
التشخيص
الفشل الكلوي
الكلى
المرضى
غسيل الكلى البريتوني
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Summary: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.
ISSN:1319-2442
2320-3838