Abstract
ObjectiveWhether automated peritoneal dialysis (APD) is a feasible strategy for urgent-start peritoneal dialysis (PD) therapy during the break-in period remains unclear. This study was conducted to compare the efficacy as well as complications among three PD modes during the break-in period.MethodsNinety-six patients treated with urgent-start PD after catheterization were retrospectively analyzed. Patients were divided into three groups, incremental continuous ambulatory PD (CAPD) group (n = 26); APD group (n = 42); and APD–CAPD group (n = 28). Clinical parameters at the end of the break-in period and 1 month after the initiation of PD treatment were collected and analyzed.ResultsCompared with the traditional incremental CAPD, APD and APD–CAPD were superior as they could effectively remove small-molecule uremic toxins and correct electrolyte imbalance (P < 0.05), while did not increase the incidence of early complications during the break-in period (P > 0.05). However, APD led to a significant decline in albumin and pre-albumin, as compared with APD–CAPD and CAPD (P < 0.05). A PD strategy consisting 6 days of APD and 3 days of CAPD showed a great advantage in preventing excessive protein loss. There were no significant differences in all tested biochemical parameters among the three groups at 1 month after treatment (all P > 0.05).ConclusionApplication of APD for urgent-start PD during the break-in period is feasible. A combination of APD and CAPD regimens seems to be a more reasonable mode.
Highlights
Peritoneal dialysis (PD) is one of the common renal replacement therapies for patients with end-stage renal disease (ESRD)
automated peritoneal dialysis (APD) and APD–continuous ambulatory peritoneal dialysis (CAPD) were superior to CAPD in clearance of serum creatinine, blood urea nitrogen and uric acid (P < 0.05)
APD and APD–CAPD were more potent in reduction of potassium and phosphorus than CAPD only (P < 0.05)
Summary
Peritoneal dialysis (PD) is one of the common renal replacement therapies for patients with end-stage renal disease (ESRD). The treatment strategy used during the break-in period allows patients to adapt to the dialysis process. There are some patients needing an urgent-start PD immediately after PD catheter insertion. In order to reduce the incidences of mechanical complications caused by urgent-start of PD treatment such as peritoneal fluid leakage and hernia, an incremental initiation of continuous ambulatory peritoneal dialysis (CAPD) is traditionally applied over the break-in period by gradual introduction of dialysate exchanges from a small-dose to full-dose therapy (e.g., from 500–800 to 2000 mL each session) [2]. Considering insufficient volume of dialysate exchanges, some researchers advocate intermittent PD (IPD) by increased times of dialysis fluid exchange [3]. Frequent dialysis exchange will increase the workload of healthcare workers, and incur increased risk of infection
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