Comparative Outcomes Between Continuous Ambulatory and Automated Peritoneal Dialysis: A Narrative Review

Bieber, Scott D.; Burkart, John M.; Golper, Thomas A.; Teitelbaum, Isaac; Mehrotra, Rajnish

doi:10.1053/j.ajkd.2013.11.025

Cited by 72 publications

(70 citation statements)

References 58 publications

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“…This question has been a recurrent matter of controversy [11] since first raised in the second half of the 1990s [7,8], with some observational studies disclosing differences [12,13] which other investigations have been unable to detect [14,15,16,17]. There are several potential explanations for these discrepancies.…”

Section: Discussionmentioning

confidence: 99%

“…Subsequently, several small randomized trials [9,10] and observational studies [11] have provided controversial results. This question is consequential because a potential handicap of APD in this field could influence the current policy of many centers of starting patients directly on APD, according to their personal preference or to general QoL perceptions.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Compared Decline of Residual Kidney Function in Patients Treated with Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis: A Multicenter Study

Fontán

Rodríguez²,

Sans³

et al. 2015

Nephron Clin Pract

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Background: There is controversy concerning the compared rates of decline of residual kidney function (RKF) in patients treated with continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). Objectives and Method: Following an observational, multicenter design, we studied 493 patients initiating peritoneal dialysis (PD) in four different Spanish units. We explored the effect of the PD modality on the rate of decline of RKF and the probability of anuria during follow-up. We applied logistic regression for intention-to-treat analyses, and linear mixed models to explore time-dependent variables, excluding those affected by indication bias. Main Results: Patients started on APD were younger and less comorbid than those initiated on CAPD. Baseline RKF was similar in both groups (p = 0.50). Eighty-seven patients changed their PD modality during follow-up. The following variables predicted a faster decline of RKF: higher (rate of decline) or lower (anuria) baseline RKF, younger age, proteinuria, nonprimary PD, use of PD solutions rich in glucose degradation products, higher blood pressure, and suffering peritonitis or cardiovascular events during follow-up. Overall, APD was not associated with a fast decline of RKF, but stratified analysis disclosed that patients with lower baseline RKF had an increased risk for this outcome when treated with this technique (HR: 2.26, 95% CI: 1.09-4.82, p = 0.023). Moreover, the probability of anuria during follow-up was overtly higher in APD patients (HR: 3.22, 95% CI: 1.25-6.69, p = 0.002). Conclusions: Starting PD patients directly on APD is associated with a faster decline of RKF and a higher risk of developing anuria than doing so on CAPD. This detrimental effect is more marked in patients initiating PD with lower levels of RKF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Compared Decline of Residual Kidney Function in Patients Treated with Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis: A Multicenter Study

Fontán

Rodríguez²,

Sans³

et al. 2015

Nephron Clin Pract

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“…For example, accidental catheter disconnection during the night can be responsible for peritonitis, and recurrent ringing alarms that cannot be solved by the patient could lead to burn-out and transfer to HD. The cycler itself may also induce anxiety in older subjects that could affect their quality of life [17] and increase the risk of technique failure [18,19]. The role of the assistance modality (family or nurse-assisted PD) on both technique failure and peritonitis occurrence also needs to be explored.…”

Section: Impact Of Assisted Peritoneal Dialysis Modalitymentioning

confidence: 99%

Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry

et al. 2018

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Background: Patients on peritoneal dialysis (PD) can be assisted by a nurse or a family member and treated either by automated PD (APD) or continuous ambulatory PD (CAPD). The aim of this study was to evaluate the effect of PD modality and type of assistance on the risk of transfer to haemodialysis (HD) and on the peritonitis risk in assisted PD patients. Method: This was a retrospective study based on data from the French Language PD Registry. All adults starting assisted PD in France between 2006 and 2015 were included. Events of interest were transfer to HD, peritonitis and death. Cox regression models were used for statistical analysis. Results: Among the 12,144 incident patients who started PD in France during the study period, 6,167 were assisted. There were 5,060 nurse-assisted and 1,095 family-assisted PD patients. Overall, 5,171 were treated by CAPD and 996 by APD. In multivariate analysis, CAPD, compared to APD, was not associated with the risk of transfer to HD (cause specific hazard ratios [cs-HR] 0.96 [95% CI 0.84–1.09]). Patients on nurse-assisted PD had a lower risk of transfer to HD than family assisted PD patients (cs-HR 0.85 [95% CI 0.75–0.97]). Neither PD modality nor type of assistance were associated with peritonitis risk. Conclusions: In assisted PD, technique survival was not associated with PD modality. Nurse-assisted patients had a lower risk of transfer to HD than family assisted patients. Peritonitis risk was not influenced either by PD modality, or by type of assistance. Both APD and CAPD should be offered to assisted-PD patients.

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“…A recent study suggested that PD results in higher P retention due to reduced clearance compared to HD [6]. This could be particularly true for patients treated with automated PD (APD) that has been reported to result in lower Na and P removal [7-9]. For Na, lower removal during APD can be explained by sodium sieving during the first hour of the dwell time due to transcellular water transport by aquaporins [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Routine Monitoring of Sodium and Phosphorus Removal in Peritoneal Dialysis (PD) Patients Treated with Continuous Ambulatory PD (CAPD), Automated PD (APD) or Combined CAPD+APD

Moor¹,

Wagner

Sayer³

et al. 2017

Kidney Blood Press Res

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Background: Adequate removal of sodium (Na) and phosphorus (P) is of paramount importance for patients with dialysis-dependent kidney disease can easily quantified in peritoneal dialysis (PD) patients. Some studies suggest that automated PD (APD) results in lower Na and P removal. Methods: In this study we retrospectively analysed our data on Na and P removal in PD patients after implementation of a routine monitoring in 2011. Patients were stratified in those treated with continuous ambulatory PD (CAPD, n=24), automated PD (APD, n=23) and APD with one bag change (CAPD+APD, n=10). Until 2015 we collected time-varying data on Na and P removal from each patient (median 5 [interquartile range 4-8] values). Results: Peritoneal Na and P removal (mmol per 24h ± standard deviation) was 102 ± 48 and 8 ± 2 in the CAPD, 90 ± 46 and 9 ± 3 in the APD and 126 ± 39 and 13 ± 2 in the CAPD+APD group (ANOVA P=0.141 and <0.001). Taking renal excretion into account total Na and P removal (mmol per 24h) was 221 ± 65 and 16 ± 5 in the CAPD, 189 ± 58 and 17 ± 6 in the APD and 183 ± 38 and 16 ± 6 in the CAPD+APD group (P=0.107 and 0.764). Over time, peritoneal removal of Na but not that of P increased in all groups. In patients with modifications of PD treatment, Na but not P removal was significantly increased over-time. Conclusions: Overall Na and P removal were similar with different PD modalities. Individualized adjustments of PD prescription including icodextrin use or higher glucose concentration can improve Na removal while P removal is mainly determined by the dialysate volume.

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Comparative Outcomes Between Continuous Ambulatory and Automated Peritoneal Dialysis: A Narrative Review

Cited by 72 publications

References 58 publications

Compared Decline of Residual Kidney Function in Patients Treated with Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis: A Multicenter Study

Compared Decline of Residual Kidney Function in Patients Treated with Automated Peritoneal Dialysis and Continuous Ambulatory Peritoneal Dialysis: A Multicenter Study

Impact of Assisted Peritoneal Dialysis Modality on Outcomes: A Cohort Study of the French Language Peritoneal Dialysis Registry

Routine Monitoring of Sodium and Phosphorus Removal in Peritoneal Dialysis (PD) Patients Treated with Continuous Ambulatory PD (CAPD), Automated PD (APD) or Combined CAPD+APD

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