Nephrology Dialysis Transplantation, Vol 14, Issue 5 1224-1228, Copyright © 1999 by Oxford University Press
G Hufnagel, C Michel, G Queffeulou, H Skhiri, H Damieri and F Mignon
Background. Automated peritoneal dialysis (APD) has
been increasingly used in recent years. Our purpose was to investigate
whether the good preservation of residual renal function (RRF) that has
been reported in patients on continuous ambulatory peritoneal dialysis
(CAPD) is also observed in APD. Methods. RRF was
determined and compared prospectively over 1 year in two groups of
peritoneal dialysis (PD) patients: 18 consecutive new patients starting on
APD (12 continuous cyclic peritoneal dialysis (CCPD) patients and six
nightly intermittent peritoneal dialysis (NIPD) patients) and 18 selected
patients who had started on CAPD at the same time and were matched for
baseline characteristics. RRF was assessed on normalized creatinine
clearance (ml/min/1.73 m2) measured before the start
of PD, at 6 months, and at 1 year. Wilcoxon's rank sum test was used to
compare differences between the two groups. Results.
Creatinine clearance (ClCr) was 6.1 ml/min in the APD group and
6 ml/min in the CAPD group at the start of PD. The monthly rate of ClCr
decrease was significantly higher in the APD group: -0.28 ml/min
vs -0.1 ml/min (P=0.04) at 6
months and -0.26 ml/min vs -0.13 ml/min
(P=0.005) at 1 year. RRF decreased at the same rate in
patients treated with NIPD or CCPD. The daily instilled volume of 3.86%
glucose dialysis solution (l/day) was higher in APD patients than in CAPD
patients: 2.5 vs 0 at 6 months and 1 year but there
was no significant difference in ultrafiltration rate (l/day) between APD
and CAPD patients at these timepoints: 0.53 vs 0.6 and
0.88 vs 0.7 respectively. There was no difference
between the two groups in body weight and blood pressure, which remained
stable in both groups throughout the study period. Conclusions.
RRF declined rapidly in APD patients whereas it was well
preserved in CAPD patients. This may be explained by the less stable fluid
and osmotic load together with the intermittent nature of APD and the
larger use of hypertonic dialysate. RRF should be closely monitored in APD
patients in order to adjust PD prescriptions and maintain adequacy.
Keywords: automated peritoneal dialysis; continuous
ambulatory peritoneal dialysis; residual renal function
ORIGINAL ARTICLES
The influence of automated peritoneal dialysis on the decrease in residual renal function
Department of Nephrology, Hôpital Bichat, 46 rue Henri-Huchard, F-75877 Paris Cedex 18, France; Association pour l'Utilisation du Rein Artificiel, Paris, France; Corresponding author
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