Comparison of Efficacy between Conventional Method and Adapted Method of Automated Peritoneal Dialysis in End Stage Kidney Disease Patients
Alongkot Suporn¹*, Wijittra Chotmongkol²*, Panibud Wongprommek³, Theenatchar Chunghom²,⁴, Renoo Tachaiya²,⁴, Chaweewan Chairit²,⁴, Sirirat Anutrakulchai²,⁵
Affiliation : ¹ Department of Medicine, Mukdahan Hospital, Mukdahan, Thailand ² Center of Excellence in Kidney Diseases, Khon Kaen University, Khon Kaen, Thailand ³ Department of Medicine, Kalasin Hospital, Kalasin, Thailand ⁴ Hemodialysis Unit of Srinagarind Hospital, Khon Kaen University, Khon Kaen, Thailand ⁵ Division of Nephrology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
* Alongkot Suporn and Wijittra Chotmongkol are equal contributors to this paper and designated as co-first authors
Background: Conventional automated peritoneal dialysis (APD-C) is typically set cycles as the constant dwell time and fill volume while adapted APD (APD-A) is modified by prescribing mixed cycles of short dwell time with small fill volume and long dwell time with large fill volume. A few previous studies revealed that APD-A improved solute clearances and ultrafiltration (UF) compared with APD-C.
Objective: Because of the limited evidence, the authors compared the efficacy of both techniques.
Materials and Methods: A randomized crossover trial was conducted in patients on peritoneal dialysis between December 2018 and January 2020. The participants were randomized for the APD-A and APD-C groups in the first 6 weeks and then continued with the second 6-week period of crossover. The difference between APD-A and APD-C was time and fill volume for each cycle but total duration of APD and total inflow volume were equally set. Comparison of primary outcomes composed of weekly Kt/Vurea, creatinine clearance (CrCL), and normalized CrCL (nCrCL). Secondary outcomes included daily UF, sodium clearance (NaCL), phosphate clearance (PhCL) and blood pressure control.
Results: 23 patients with mean age of 61.1±11.8 years and median APD vintage of 23 months completed the two sequences of study. The APD-A group had significantly higher CrCL [48.47 (36.06 to 76.75) vs. 46.04 (32.23 to 61.71) L/week, p=0.022], nCrCl [53.24 (45.87 to 72.91) vs. 49.44 (37.94 to 58.15) L/week/1.73 m2, p=0.02], serum bicarbonate level [25.5±2.8 vs. 24.1±2.4 mEq/L, p=0.01] and hemoglobin level [10.93±1.82 vs. 10.21±1.93 g/dL, p=0.04]. No significant difference of Kt/Vurea, NaCL, PhCL, UF and blood pressure.
Conclusion: APD-A group had higher efficacy in creatinine clearances compared with the APD-C group. However, there was no improvement in other clearances and UF which might be from too small sample size. Currently, APD-A is an optional practice for individualized and optimal treatment.
Received 11 April 2024| Revised 24 June 2024| Accepted 15 July 2024
DOI: 10.35755/jmedassocthai.2024.S01.S126-S135
Keywords : Adapted automated peritoneal dialysis; Adequacy of peritoneal dialysis; Creatinine clearance; Sodium clearance; Phosphate clearance;
Blood pressure
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