A randomized controlled comparative study of different fluid exchange modes in urgent-start peritoneal dialysis in patients with end-stage renal disease: automated peritoneal dialysis combined with manual fluid exchange vs. manual fluid exchange alone

Abstract

During urgent-start peritoneal dialysis (USPD) in end-stage renal disease (ESRD) patients, both adequate dialysis and skill training for fluid exchange are essential. However, automated peritoneal dialysis (APD) alone or manual fluid exchange peritoneal dialysis (MPD) alone could meet the above demands. Therefore, our study combined APD with MPD (A-MPD), and compared A-MPD with MPD, aiming to find the most appropriate treatment mode. This was a single-center, prospective, randomized controlled study. All eligible patients were randomized into the MPD and A-MPD groups. All patients underwent a five-day USPD treatment 48 h after catheter implantation, and they were followed up for six months after discharge. Overall, 74 patients were enrolled in this study. Among these, 14 and 60 patients quit due to complications during USPD and completed the study (A-MPD = 31, MPD = 29), respectively. Compared with MPD, the A-MPD treatment mode had a better effect on removing serum creatinine, blood urea nitrogen, and potassium and improving serum carbon dioxide combining power levels; it had less time expenditure on the fluid exchange by nurses ( p < 0.05). In addition, patients in the A-MPD group had higher scores on the skill tests than those in the MPD group ( p = 0.002). However, no significant differences in short-term peritoneal dialysis (PD) complications, PD technical survival rate, or mortality were found between the two groups. Therefore, the A-MPD mode could be recommended as an adoptable and suitable PD modality for USPD in the future.

Urgent-Start Peritoneal Dialysis: Current State and Future Directions

“…Two studies investigated the outcomes of patients prescribed APD, CAPD, or combination APD-CAPD in patients requiring USPD, where patients began on APD for 3 days and then switched to CAPD. Both studies demonstrated that combination APD-CAPD is superior at removing small-molecule toxins and correcting electrolyte imbalances [21,22]. In one of these studies, the APD-alone group demonstrated decreases in serum albumin that were not shown in the APD-CAPD group, suggesting that CAPD may be suggestive against protein loss.…”