Automated Peritoneal Dialysis Group Research Articles

Remote monitoring of automated peritoneal dialysis reduces mortality, adverse events, and hospitalizations: a cluster randomized controlled trial.

Remote monitoring (RM) of patients on automated peritoneal dialysis (APD) prevent complications and improve treatment quality. We analyzed the effect of RM-APD on mortality and complications related to cardiovascular disease (VD), fluid overload and insufficient dialysis efficiency. In a cluster-randomized, open-label, controlled trial, 21 hospitals with APD programs were assigned to use either RM-APD (10 hospitals; 403 patients) or conventional APD (11 hospitals; 398 patients) for the treatment of adult patients starting PD. Primary outcomes were time to first event of: 1) Composite Index-1 comprising all-cause mortality, first adverse events and hospitalizations of any cause, and 2) Composite Index-2 comprising cardiovascular mortality, first adverse event and hospitalizations related to CVD, fluid overload and insufficient dialysis efficiency. Secondary outcomes were time to first event of individual components of the two composite indices, and rates of adverse events, hospitalizations, unplanned visits, and transfer to hemodialysis. Patients were followed for a median of 9.5 months. Primary outcomes were evaluated by competing-risk analysis and restricted mean survival time (RMST) analysis. While time to reach Composite Index-1 did not differ between the groups, Composite Index-2 was reached earlier (ΔRMST: -0.85 months; p=0.02), and all-cause mortality (55 vs. 33 deaths, p=0.01; sHR 1.69 (95%CI 1.39-2.05), p<0.001) and hospitalizations of any cause were higher in APD group than in RM-APD as were cardiovascular deaths (24 vs. 13 deaths, p=0.05; sHR 2.44 (95%CI 1.72 - 3.45), p<0.001) and rates of adverse events and hospitalizations related to CVD, fluid overload or insufficient dialysis efficiency. Dropouts were more common in the APD group (131 vs. 110, p=0.048). This randomized controlled trial shows that remote monitoring may add significant advantages to APD, including improved survival and reduced rate of adverse events and hospitalizations, which can favorably impact the acceptance and adoption of the therapy.

A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD

Peritoneal dialysis (PD) shows promise for urgent-start dialysis in end-stage renal disease (ESRD), with automated PD (APD) having advantages. However, there is limited multicenter randomized controlled trial (RCT) evidence comparing APD with temporary hemodialysis (HD) for this indication in China. This multicenter RCT enrolled 116 patients with ESRD requiring urgent dialysis from 11 hospitals, randomized to APD or HD. Patients underwent a 2-week treatment with APD or HD via a temporary central venous catheter (CVC), followed by a maintenance PD. Outcomes were assessed over 12 months during 8 visits. The primary outcome was dialysis-related complications. The 1-year incidence of dialysis-related complications was significantly lower in the APD group than in the HD group (25.9% vs. 56.9%, P= 0.001). No significant differences were found between the groups in terms of PD catheter survival rates (P= 0.388), peritonitis-free survival rates (P= 0.335), and patient survival rates (P= 0.329). In terms of health economics, the total direct medical cost of the initial hospitalization for patients with ESRD was significantly lower in the APD group (27,008.39 CNY) than in the HD group (42,597.54 CNY) (P= 0.001), whereas the duration of the first hospital stay showed no significant difference (P= 0.424). For patients with ESRD needing urgent initiation of dialysis, APD was associated with a lower incidence of dialysis-related complications and lower initial hospitalization costs compared with HD, with no significant differences in PD catheter survival rate, peritonitis-free survival rates, or patient survival rates. These findings can guide clinical decision-making for the optimal dialysis modality for patients requiring urgent dialysis initiation.

Automated peritoneal dialysis as a cost-effective urgent-start dialysis option for ESRD patients: A prospective cohort study.

Several studies have reported the feasibility of urgent-start peritoneal dialysis (PD) as an alternative to hemodialysis (HD) using a central venous catheter (CVC). However, the cost-effectiveness of automated peritoneal dialysis (APD) as an urgent-start dialysis modality has not been directly evaluated, especially in China. We prospectively enrolled patients with end-stage renal disease (ESRD) who required urgent-start dialysis at a single center from March 2019 to November 2020. Patients were grouped according to their urgent-start dialysis modality (APD and HD). Urgent-start dialysis conducted until 14 days after PD catheter insertion. Then, PD was maintained. Each patient was followed until July 2021 or death or loss to follow-up. The primary outcome was the incidence of short-term dialysis-related complications. The secondary outcome was the cost and duration of the initial hospitalization. Technique survival, peritonitis-free or bacteriamia-free survival and patient survival were also compared. Sixty-eight patients were included in the study, of whom 36 (52.9%) patients were in APD group. Mean follow-up duration was 20.1 months. Compared with the HD group, the APD group had significantly fewer short-term dialysis-related complications. The cost of initial hospitalization was also significantly lower in APD patients. There was no significant difference between APD and HD patients with respect to duration of the initial hospitalization, technique survival rate, peritonitis-free or bacteriemia-free survival rate, and patient survival rate. Among ESRD patients with an urgent need for dialysis, APD as urgent-start dialysis modality, compared with HD using a CVC, resulted in fewer short-term dialysis-related complications and lower cost.

The reliability and success of peritoneal dialysis during the COVID-19 pandemic.

We evaluated the symptoms, changes in laboratory findings during the novel coronavirus disease (COVID‐19) pandemic, and the effect of depression in patients with peritoneal dialysis (PD). This is an observational and cross‐sectional study. All patients were asked to fill the clinical assessment form and Beck depression and anxiety inventory. Also, the last two laboratory evaluations during this period were examined. A total of 123 patients performing PD were included. None of the patients were diagnosed with COVID‐19. In the total study population, parathyroid hormone (PTH), serum albumin, phosphorus and ferritin levels significantly elevated at the end of 97 ± 31 days. PTH and phosphorus levels remained stable in remote monitoring automated PD (RM‐APD) group (p = 0.4 and p = 0.5), they tended to increase in continuous ambulatory PD group and significantly increased in automated PD group (p = 0.09 and p = 0.01 for PTH and p = 0.06 and p = 0.001 for phosphorus, respectively). Moderate to severe depression was associated with dyspnoea, weight gain more than 5 kg, fatigue, palpitation and increased anxiety. PD is a reliable and successful form of dialysis and can be safely administered even if hospital access is restricted. Also, RM‐APD may be a better choice because of providing more stable bone‐mineral metabolism. Moreover, evaluating depression and anxiety is essential for the accurate clinical assessment.

Comparison of patient survival and technique survival between continuous ambulatory peritoneal dialysis and automated peritoneal dialysis.

This retrospective cohort study compared patient survival and technique survival between patients on continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) using recent data at a single tertiary medical center in Taiwan. From medical records, we identified incident 459 CAPD patients and 266 APD patients on dialysis for at least 90 days and aged more than 18 years to estimate mortality and technique failure rates, and related hazard ratio (HR) and 95% confidence interval (CI) from 2007 to 2018. There were more women (52.3%) in the CAPD group, whereas patients in the APD group were younger. Compared to CAPD patients, APD patients had a lower mortality rate (2.83 vs. 5.79 per 100 person-years) with an adjusted HR of 0.69 (95% CI = 0.47-1.02), and a lower technique failure rate (9.70 vs. 17.52 per 100 person-years) with an adjusted HR of 0.65 (95% CI = 0.51-0.83). Further subgroup analyses revealed that, compared to CAPD, APD was associated with a significant lower risk of technique failure in male patients, patients aged 50-65 years, diabetic patients, patients without cardiovascular disease (CVD), patients with higher peritoneal permeability, or patients initiating PD in an earlier era. The mortality risk was not significant between CAPD and APD patients. APD is associated with a lower risk of technique failure than CAPD, particularly for male patients, and patients aged 50-65 years, with diabetes, without CVD, with high or high average peritoneal permeability, or initiating PD in an earlier era.

Health economic evaluation of peritoneal dialysis based on cost-effectiveness in Japan: a preliminary study.

BackgroundIn Japan, the medical expenditures associated with dialysis have garnered considerable interest; however, a cost-effectiveness evaluation of peritoneal dialysis (PD) is yet to be evaluated. In particular, the health economics of the “PD first” concept, which can be advantageous for clinical practice and healthcare systems, must be evaluated.MethodsThis multicenter study investigated the cost-effectiveness of PD. The major effectiveness indicator was quality-adjusted life year (QALY), with a preference-based utility value based on renal function, and the cost indicator was the amount billed for a medical service at each medical institution for qualifying illnesses. In comparison with hemodialysis (HD), a baseline analysis of PD therapy was conducted using a cost-utility analysis (CUA). Continuous ambulatory PD (CAPD) and automated PD (APD) were compared based on the incremental cost-utility ratio (ICUR) and propensity score (PS) with a limited number of cases.ResultsThe mean duration since the start of PD was 35.0±14.4 months. The overall CUA for PD (179 patients) was USD 55,019/QALY, which was more cost effective (USD/monthly utility) compared with that for HD for 12–24 months (4,367 vs. 4,852; p<0.05). The CUA reported significantly better results in the glomerulonephritis group than in the other diseases, and the baseline CUA was significantly age sensitive. The utility score was higher in the APD group (mean age, 70.1±3.5 years) than in the CAPD group (mean age, 70.6±4.2 years; 0.987 vs. 0.860; p<0.05, 9 patients). Compared with CAPD, APD had an overall ICUR of USD 126,034/QALY.ConclusionThe cost-effectiveness of PD was potentially good in the elderly and in patients on dialysis for <24 months. Therefore, the prevalence of PD may influence the public health insurance system, particularly when applying the “PD first” concept.

Comparison of Exit-Site Infection Frequency in Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis Patients: A Single-Center Experience.

Objectives:Catheter exit-site infection (ESI) is generally caused by skin flora. Continuous ambulatory peritoneal dialysis (CAPD) patients have more contact with their catheters than automated peritoneal dialysis (APD) patients as a result of performing multiple exchanges per day. The aim of the present study was to compare the frequency of ESIs between these 2 peritoneal dialysis (PD) modalities.Methods:PD patients from 2001 to 2015 were enrolled in the study. Patients transferred from CAPD to APD were excluded. All of the data were collected retrospectively. The rate of ESI occurrence and culture results in the CAPD and APD groups were compared.Results:The data of 280 patients were evaluated. APD patients represented 23.2% of the study cohort. Prevalence of peritonitis was 87.6% if a patient had an ESI and 50.7% if there was no ESI (p=0.000). The frequency of ESI was similar between the 2 peritoneal dialysis modalities (p=0.343). There was a statistically significant difference in the causative organism of infection between the 2 groups (p=0.021).Conclusion:The ESI rate was similar in the CAPD and APD patients though CAPD requires more exchanges, and therefore there is more contact with the catheter. All PD patients, regardless of the treatment modality used, are expected to perform exchanges according to standard rules for connecting the catheter to the PD solution bag. As long as patients observe these guidelines, there would appear to be no increased ESI risk related specifically to the modality.

Health-related quality of life in children and adolescents with end stage renal disease receiving dialysis in Johannesburg

Background . Limitations in daily activities can have a major impact on the quality of life in children and adolescents. Long-term dialysis tends to restrict children from carrying out similar activities to those of their peers. Objective. To analyse the health-related quality of life of children and adolescents with end-stage renal disease on dialysis in Johannesburg. Methods . A hospital-based, cross-sectional study which assessed the health-related quality of life (HRQOL) of patients undergoing haemodialysis (HD), automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) using the Pediatric Quality of Life Inventory (PedsQL 3.0) and end-stage renal disease (ESRD) module as the instrument. The instrument is a questionnaire comprising 7 domains with a total of 34 questions/items. Child reports as well as parent proxy reports were obtained. Questionnaires were administered to all patients and parents/caregivers of children on all forms of chronic dialysis. Results . Twenty-seven children and adolescents were studied. The mean (standard deviation (SD)) age of the study participants was 14.4 (4.8) years (range 5 - 25). Fourteen patients were on HD while 13 were on peritoneal dialysis (8 on APD and 5 on CAPD). Those on HD were significantly older, with a mean (SD) age of 16.6 (3.2) years, compared with the mean (SD) age of those on PD, which was 12.1 (5.3) years ( p =0.007). Moreover, those on HD had been on dialysis for a longer period of time, with a mean (SD) period of 4.5 (3.3) years, compared with those on PD who had been on dialysis for a mean (SD) duration of 1.7 (0.8) years ( p =0.006). The HRQOL was lower in most domains in the HD group compared with the PD group. Among the patients on PD, the HRQOL scores were lower in the APD group compared with the CAPD group ( p >0.05). The ratings by the parent proxies were higher than those reported by the children themselves in most domains. When compared with the population mean HRQOL scores derived from a healthy paediatric population, the mean HRQOL scores of the children with ESRD on dialysis were significantly lower for both child ( t =–11.1; p =0.001) and parent proxy reports ( t =–7.2; p =0.001). Conclusion . HRQOL is low in children with ESRD receiving chronic dialysis. It tends to be much lower in children on HD when compared with those on PD. PD appears to be more acceptable to children and parents/caregivers than HD.

PUK5 - A Pilot Study on Cost Evaluation of Urgent Start Automated Peritoneal Dialysis and Hemodialysis in the Treatment of End-Stage Renal Disease in São Paulo, Brazil

Compare the outcomes and the direct medical costs of urgent start hemodialysis (HD) and automated peritoneal dialysis (APD) by six months in a Brazilian center. In this prospective study, we describe dialysis related events, resources used and amounts reimbursement for them by the Brazilian public health care system in a cohort of patients on urgent start HD and APD. We assessed 20 patients on each method in the first six months of therapy. We considered direct medical costs the amounts reimbursed for hospitalization, laboratory exams, chronic kidney disease (CKD) specific medications, maintenance dialysis, clinical complications related to dialysis, dialysis access and its complications. There was no difference between the APD group and HD group in age (55.3±15.2 vs 57.6±15.0, p=0.65), male sex (70 vs 60%, p=0.74), transplantation (0 in both groups) and mortality (0 vs 10%, p=0.48). There was difference in etiology of CKD (diabetes: 45 in APD vs 10% in HD group, p=0.03). The total direct cost per patient–semester was similar: US$6091.7±1289.4 for urgent start APD and US$ 6209.1±1600 for HD (p=0.45). By category, the main direct costs consisted of maintenance dialysis (75.2 for HD vs. 80.3% for APD, p=0.04), hospitalization (0 for HD vs 2.1% for APD, p<0.001), laboratory exams (1.6 for HD vs 1.7% for APD, p=0.29), dialysis access and its mechanical complications (9.3% for HD vs. 3.7% for APD, p<0.001), infectious treatment (2.54 vs 1.1%, p=0.94) and medications (12.3 for HD vs. 9.6% for APD, p=0.15). Overall costs were similar in urgent start APD and HD and maintenance dialysis represented the most important source of costs for both modalities, being higher for APD. Unplanned HD had higher dialysis access costs than PD, while PD had higher costs with hospitalizations than HD. These are interesting characteristics of unplanned dialysis modalities.

Application of automated peritoneal dialysis in urgent-start peritoneal dialysis patients during the break-in period

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.

Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience

Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p < 0.05). Percentage of peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p < 0.05). Time to develop peritonitis was 10.25 ± 3.1 months in CAPD compared to 16.1 ± 4 months in APD (p < 0.001). Relapse and recurrence rates were similar in both groups. Median patient survival in CAPD and APD groups with peritonitis was 13.1 ± 1 and 14 ± 1.4 months respectively (p = 0.3) whereas in peritonitis free patients it was 15 ± 1.4 months in CAPD and 23 ± 3.1 months in APD (p = 0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.

Objective and subjective sleep disorders in automated peritoneal dialysis.

BackgroundAutomated peritoneal dialysis (APD) is one of the fastest growing dialysis modalities. It is unknown whether sleep and mood are disturbed while performing repeated overnight exchanges.ObjectivesIn this report, we aim to describe and compare the prevalence of sleep-disordered breathing (SDB), periodic limb movements (PLMS), poor sleep quality (SQ), and depression among APD patients compared with stages 3b–5 (estimated glomerular filtration rate ≤44 ml/min/1.73 m2) chronic kidney disease (CKD) and hemodialysis (HD) patients.DesignThis is a cross-sectional, descriptive study.SettingStudy participants were recruited from outpatient nephrology clinics, local dialysis centers, and the Thomas E. Starzl Transplant Institute in Western Pennsylvania between April 2004 and July 2009.PatientsThere were 186 participants in this study including 22 APD patients, 89 CKD patients, and 75 HD patients.MeasurementsIn-home polysomnography was performed and two questionnaires were completed, the Pittsburgh Sleep Quality Index (PSQI) and the Patient Health Questionnaire-9 (PHQ-9).MethodsSDB and PLMS were quantified by in-home unattended polysomnography; poor SQ was defined by a score >5 on the PSQI, and the presence of moderate to severe depression was defined by a score >5 on the PHQ-9.ResultsThe APD patients had a median age of 37.5 years, were predominantly female (72.7 %), and had a median body mass index (BMI) of 23.8 kg/m2. In univariate analyses, APD patients had significantly lower apnea-hypopnea index compared to HD patients by 12.2 points (likelihood ratio test p = 0.008) and revealed the least percent of TST with nocturnal hypoxemia compared to CKD patients by 2.7 points, respectively (likelihood ratio test p = 0.01). The APD group had also significantly greater stages 3 to 4 sleep compared to the CKD patients by 8.6 points (likelihood ratio test p = 0.009). In multivariate analyses and after adjustment for age, gender, race, and BMI, both APD and HD patients had higher average PSQI scores than CKD patients by 2.54 and 2.22 points, respectively (likelihood ratio test p = 0.005). No other comparisons of sleep parameters among groups reached statistical significance.LimitationsThe limitations of this study are the small sample size of the APD population and the demographic and clinical differences among the three study groups.ConclusionsDespite differences in univariate analyses, after multivariate adjustment, APD patients had similar sleep parameters and sleep architecture and as poor SQ and symptoms of depression as HD patients. Future studies with larger APD cohorts are needed.

The effect of strict volume control on cardiac biomarker and arterial stiffness in peritoneal dialysis patients

Arterial stiffness is a risk marker for cardiovascular events in peritoneal dialysis (PD) patients. Strict volume control strategy has been shown to result in better cardiac functions and control of hypertension in these patients. The aim of the study was to identify the determinants of arterial stiffness and evaluate the changes in cardiac biomarkers in PD patients under strict volume control strategy. 58 PD patients were enrolled into this prospective observational study. Arterial stiffness determined by aortic pulse wave velocity (PWV), echocardiography, ambulatory blood pressure and NT-pro-BNP levels were measured at baseline and at first year. The mean age of the patients was 46.4 ± 14 years. 30 patients were on automated PD (APD) and 28 on continuous ambulatory PD (CAPD) group. In both groups, there were significant differences in PWV values at baseline and at the end of the study. A similar decrease was observed with NT-proBNP and PWV levels. In addition, a significant improvement was found in echocardiographic parameters in all patients. Comparison of APD and CAPD groups with respect to change in one year, showed no difference in echocardiographic findings, while the reduction in PWV, NTproBNP and blood pressure values was higher in the CAPD group. In PD patients, strict volume control leads to a reduction in NT-pro-BNP levels, better control of blood pressure and significant improvements in cardiac functions and arterial stiffness.

Automated peritoneal dialysis in Hong Kong: There are two distinct groups of patients

To compare the clinical outcome between continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD) in specific subgroups of patients. We reviewed the clinical outcome of 90 consecutive incident APD patients and 180 CAPD patients in our centre. The median follow up was 21.9 months (inter-quartile range, 9.5 to 46.5 months). The APD group was younger and had a lower Charlson's score than the CAPD group. Furthermore, the APD group had a highly skewed distribution of the Charlson's score, indicating the possibility of two different groups of patients. Multivariate analysis showed that in addition to the treatment mode (APD vs CAPD) and Charlson's score, there was a significant interaction between the two (P = 0.043) on patient survival. For patients with Charlson's score ≤6, the APD group had a significantly better patient survival than the CAPD group (78.3% vs. 65.4% at 5 years, P = 0.039), while for patients with Charlson's score ≥7, the APD group had a worse patient survival than the CAPD group (16.3% vs. 48.4% at 5 years, P = 0.028). Similarly, Charlson's score and its interaction with treatment mode, but not the APD group per se, were independent predictors of technique survival (P = 0.013). For patients with Charlson's score ≥7, the APD group had a significantly lower technique survival than the CAPD group (8.8% vs. 34.3%, P = 0.001), while for patients with Charlson's score ≤6, the technique survival was similar (44.4% vs. 42.5%, P = 0.15). Peritonitis-free survival was 35.2% and 32.2% for APD and CAPD groups, respectively (P = 0.021), and the difference was not affected by Charlson's score. Comorbid diseases had a significant interaction with the mode of PD on patient and technique survival of incident PD patients. Our result suggests that APD may offer benefit in, and only in, young patients with minimal comorbid diseases.

Daytime Sleepiness and Quality of Life in Peritoneal Dialysis Patients

We aimed to compare automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) therapy with regard to patients' excessive daytime sleepiness (EDS) and quality of life (QOL). EDS was assessed with the Epworth Sleepiness Scale (ESS) and QOL with the Medical Outcomes Study 36-Item Short Form (SF-36) health survey. We included 59 patients (CAPD/APD, 30/29; male/female, 33/26; age, 45.3±15.8 years; dialysis duration, 42.0±33.6 months). The CAPD and APD groups were similar with respect to factors that affected sleep quality (age, sex, duration of PD), smoking, alcohol intake, socioeconomic status, body mass index, comorbid disease, and various laboratory parameters. Although one patient (3.3%) treated with CAPD and four patients (13.8%) treated with APD experienced EDS, there was no significant differences in ESS scores between the CAPD and APD patients. There was no difference in the SF-36 total and subscale scores when APD patients were compared with CAPD patients. The independent predictors of ESS were the serum albumin level (β= -2.04, P<0.01), total SF-36 score (β= 0.08, P=0.02), social functioning score (β= -2.47, P=0.01), and role-emotional subscale score (β= -1.12, P=0.05). The incidence of EDS was slightly higher in APD patients, but it did not negatively affect daily activities or QOL.

Similar Peritonitis Outcome in Capd and APD Patients with Dialysis Modality Continuation during Peritonitis

As few data exist on treatment of peritonitis in patients on automated peritoneal dialysis (APD), and as pharmacokinetics of several antibiotics are reported to be unfavorable in APD, some favor switching to continuous ambulant PD (CAPD) while treating APD-related peritonitis. We explored whether treating peritonitis with patients continuing their usual PD modality had an effect on outcome. We performed a retrospective analysis of the 508 episodes of PD-associated peritonitis seen in 205 patients in our center from January 1993 to January 2007. During this period, the standard initial therapy for PD-related peritonitis was a combination of intraperitoneal gentamicin and rifampicin. There was no difference in cure rate between CAPD and APD groups. Likewise, initial and maximal leukocyte counts in the PD fluid (PDF), relapse rates, catheter removal rates, and death during treatment of peritonitis were similar in the CAPD and APD groups. Median (interquartile range) duration of elevated leukocyte count in PDF was longer in APD: 5.0 (3.0 - 9.0) days versus 4.0 (2.5 - 7.0) days in CAPD (p <0.001). APD patients were treated with antibiotics longer than CAPD patients: 16.0 (12.5 - 21.0) versus 15.0 (12.0 - 18.0) days (p = 0.036). Also, after correction for possible confounders, odds ratios for death and for the combined end point death or catheter removal showed no difference when patients treated for peritonitis stayed on their own modality. Regarding rate of relapse, mortality, or the combined end point mortality plus catheter removal, we found no difference between CAPD and APD patients continuing their own PD modality during treatment of PD-related peritonitis. Intermediate end points such as duration of elevated PDF leukocyte count and duration of antibiotic treatment were longer in APD patients.

Comparison of Blood Pressure Control and Left Ventricular Hypertrophy in Patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) and Automated Peritoneal Dialysis (APD).

This study aimed to investigate the influence of different peritoneal dialysis regimens on blood pressure control, the diurnal pattern of blood pressure and left ventricular hypertrophy in patients on peritoneal dialysis. Forty-four patients undergoing peritoneal dialysis were enrolled into the study. Patients were treated with different regimens of peritoneal dialysis: 26 patients on continuous ambulatory peritoneal dialysis (CAPD) and 18 patients on automated peritoneal dialysis (APD). All patients performed 24-hour ambulatory blood pressure monitoring (ABPM) and echocardiography. Echocardiography was performed for measurement of cardiac parameters and calculation of left ventricular mass index (LVMI). There were no significant differences in average of systolic and diastolic blood pressure during 24-hour, daytime, and nighttime between CAPD and APD groups. There were no significant differences in diurnal variation of blood pressure, systolic and diastolic blood pressure load, and LVMI between CAPD and APD groups. LVMI was associated with 24 hour systolic blood pressure load (r = 0.311, P < 0.05) and daytime systolic blood pressure load (r = 0.360, P < 0.05). In conclusion, this study found that there is no difference in blood pressure control, diurnal variation of blood pressure and left ventricular hypertrophy between CAPD and APD patients. The different peritoneal dialysis regimens might not influence blood pressure control and diurnal variation of blood pressure in patients on peritoneal dialysis.

Qualidade de Vida: comparação entre diálise peritoneal automatizada e hemodiálise

OBJETIVO: Avaliar a Qualidade de Vida relacionada à saúde em pacientes submetidos à Diálise Peritoneal Automatizada (DPA) e Hemodiálise em um centro de diálise satélite no Município de São Paulo. MÉTODOS: Este estudo observacional transversal, incluiu 101 pacientes com idade entre 18-75 anos, em terapia há mais de 90 dias e que compreenderam o questionário. RESULTADOS: O grupo em Hemodiálise (n=79) estava em terapia há mais tempo (p=0.001) e tinha albumina sérica maior (p&lt;0.001) comparado ao grupo em DPA (n=22). Os escores do SF-36 foram semelhantes em várias dimensões, exceto pelo escore de Aspectos Físicos que foi maior nos pacientes em Hemodiálise (p=0.03). Não houveram interações significativas entre SF-36 e as demais variáveis que explicassem esta diferença. CONCLUSÃO: A Qualidade de Vida foi semelhante entre as modalidades, porém o escore de Aspectos Físicos foi menor para pacientes em Diálise Peritoneal Automatizada.

Automated Peritoneal Dialysis in Children and Adolescents—Benefits: A Survey of Patients and Parents on Health-Related Quality of Life

Automated peritoneal dialysis (APD) benefits children on dialysis and their parents by allowing for more daytime freedom and a more normal life. We carried out a survey on health-related quality of life (HRQOL) in children and adolescents from our end-stage renal disease program, including those on APD and hemodialysis (HD), and those who had received a kidney transplant (TX). Parents of patients under 18 years of age were also interviewed. The questionnaire on QOL was adapted from the Pediatric Quality of Life Inventory and grouped into seven aspects for which patients and parents were asked to assess the frequency of related problems during the preceding 3 months. We surveyed eligible children among the APD, HD, and TX patients enrolled in our program, and we surveyed the parents of the patients under 18 years of age. For APD, patients and parents both gave their most favorable scores to the peer activities and relationships and family activities and relationships aspects. In the TX group, the family activities and relationships aspect was also scored most favorably of all aspects. Notably, we observed no significant difference between the total scores for the APD and TX groups among patients and parents alike. Although the survey provided only a "snapshot" of HRQOL, the assessment by APD patients and their parents seems to be comparable to that by TX patients and their parents.

Acid-base profile in patients on PD

Acid-base profile in patients on PD. Secular trends in dialysis dose in peritoneal dialysis (PD) and modes of dialysis delivery [automated PD (APD) versus continuous ambulatory PD (CAPD)] require a reexamination of acid-base status in patients treated with these renal replacement modalities. We explored steady-state acid-base profile and its determinants in 175 patients on CAPD and 77 patients on APD. The majority (62% to 70%) of patients had serum bicarbonate levels in the normal range, and a minority (17% to 27%) had values just above 28 mEq/L. Only a small percentage (10% to 12%) of patients in either the CAPD or the APD groups had a serum HCO3 less than 22 mEq/L, an indication of the successful correction of acidosis in most patients. The anion gap was elevated (> 16 mEq/L) in the majority of patients on CAPD and APD and bore an inverse relationship to serum HCO3 and a direct relationship to serum albumin and serum phosphate. In CAPD patients, but not APD patients, a significant inverse relationship was observed between the anion gap and peritoneal permeability as assessed by four-hour D/P(creatinine). The correction of acidosis in PD appears to be predominantly achieved by the continuous supplementation of alkali via dialysis, with residual renal function not differentiating the degree of correction. Steady-state serum bicarbonate in patients on CAPD appeared to be responsive to the underlying peritoneal membrane permeability characteristics of the patient that govern alkali loss and gain, but the higher dialysate volumes in APD appear to override this effect. Higher albumin, blood urea nitrogen (BUN), and phosphate in patients with lower HCO3 suggest a discrepancy between daily acid load and dialysis dose.