Abstract
BackgroundOptimal fluid balance for peritoneal dialysis (PD) patients requires both water and sodium removal. Previous studies have variously reported that continuous ambulatory peritoneal dialysis (CAPD) removes more or equivalent amounts of sodium than automated PD (APD) cyclers. We therefore wished to determine peritoneal dialysate losses with different PD treatments.MethodsPeritoneal and urinary sodium losses were measured in 24-h collections of urine and PD effluent in patients attending for their first assessment of peritoneal membrane function. We adjusted fluid and sodium losses for CAPD patients for the flush before fill technique.ResultsWe reviewed the results from 659 patients, mean age 57 ± 16 years, 56.3% male, 38.9% diabetic, 24.0% treated by CAPD, 22.5% by APD and 53.5% APD with a day-time exchange, with icodextrin prescribed to 72.8% and 22.7 g/L glucose to 31.7%. Ultrafiltration was greatest for CAPD 650 (300–1100) vs 337 (103–598) APD p < 0.001, vs 474 (171–830) mL/day for APD with a day exchange. CAPD removed most sodium 79 (33–132) vs 23 (− 2 to 51) APD p < 0.001, and 51 (9–91) for APD with a day exchange, and after adjustment for the CAPD flush before fill 57 (20–113), p < 0.001 vs APD. APD patients with a day exchanged used more hypertonic glucose dialysates [0 (0–5) vs CAPD 0 (0–1) L], p < 0.001.ConclusionCAPD provides greater ultrafiltration and sodium removal than APD cyclers, even after adjusting for the flush-before fill, despite greater hypertonic usage by APD cyclers. Ultrafiltration volume and sodium removal were similar between CAPD and APD with a day fill.
Highlights
Peritoneal dialysis (PD) is an established treatment for patients with end-stage kidney disease
The majority of continuous ambulatory peritoneal dialysis (CAPD) patients and those treated by automated peritoneal dialysis (APD) with a day-time exchange were prescribed icodextrin, and more hypertonic glucose exchanges were used by APD patients with a day-time exchange
Net peritoneal ultrafiltration and sodium removal was greatest with CAPD, this fell after adjustment for the fill before flush technique, net ultrafiltration volume and peritoneal sodium loss remained greater for CAPD compared to APD (p < 0.001), but not for APD with a day-time icodextrin exchange (Figs. 1, 2)
Summary
Peritoneal dialysis (PD) is an established treatment for patients with end-stage kidney disease. After peritonitis [1], failure to achieve adequate ultrafiltration is the commonest cause of PD technique failure, and just as there are targets for small solute clearances for PD patients the European Automated Peritoneal Dialysis Outcomes Study (EAPOS). Patients with faster peritoneal transport are reported to have lower technique survival when treated by continuous ambulatory peritoneal dialysis (CAPD) [3]. The introduction of automated peritoneal dialysis (APD) cyclers has been reported to reduce technique failure rates for faster peritoneal transporters [3], and studies from both the USA and Brazil have reported greater PD technique and patient survival with APD compared to CAPD. Previous studies have variously reported that continuous ambulatory peritoneal dialysis (CAPD) removes more or equivalent amounts of sodium than automated PD (APD) cyclers. Ultrafiltration volume and sodium removal were similar between CAPD and APD with a day fill
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