Outcome of patients treated with automated peritoneal dialysis: effects of selection of patients

To determine the effect of selection of peritoneal dialysis patients who used auto-mated PD (APD) as a first renal replacement therapy (RRT) option,we studied two groups of adult chronic kidney disease (CKD) patients treated with APD over a period of 4 years: group 1 included 30 patients in whom APD was the first choice for RRT and group 2 included 40 patients transferred from failed hemodialysis (HD) treatment. Both groups were matched for the original causes of CKD and comorbid conditions. However,group 1 had significantly higher residual renal function (RRF) than group 2 [glomerular filtration rate (GFR) 11.85 ± 4 mL/min and urine output 995 ± 465 mL/day vs. 3.69 ± 3.7 mL/min and 340 ± 447 mL/day,respectively,P = 0.0001] and Kt/v (2.7 ± 0.7 vs. 1.9 ± 0.4, respectively, P = 0.006). Most of the patients were compliant with their APD prescription, performed ideal PD techniques,achieved adequate dialysis and fluid ultra-filtration,and experienced much less than average infectious and non-infectious complications. However,group 1 achieved better clinical outcome than group 2,including relatively higher survival rate and kidney transplantation,significantly fewer episodes of peritonitis per year (0.09 vs. 0.14,respectively,P = 0.0001),higher serum albumin (2.95 ± 0.3 vs. 2.7 ± 0.27 g/dL,respectively,P = 0.035),hemoglobin (11.5 ± 0.9 vs. 10.6 ± 0.7 g/dL,respectively,P = 0.022) and lower parathormone levels (283 ± 117 vs. 389 ± 269 pg/mL,respectively,P = 0.02). They also maintained significantly higher total fluid removal compared to group 2 (1120 ± 330 vs. 560 ± 300 mL/day,respectively,P = 0.004),higher RRF (GFR 8 ± 2.6 mL/min vs. 1.8 ± 2.4 mL/min,respectively,P = 0.0001),and urine output (556 ± 447 mL/day vs. 240 ± 347 mL/day,respectively,P = 0.004),and significantly higher Kt/v (2.8 ± 0.7 vs. 1.9 ± 0.4,respectively,P = 0.2). In conclusion,in CKD patients,PD is a viable initial modality of RRT,and with better RRF may have a better outcome than as a secondary choice.