MO018ADAPTIVE REGIME OF CONTINUOUS AMBULATORY PERITONEAL DIALYSIS

Abstract

Introduction and Aims: Standard regime of peritoneal dialysis (SR PD) for the majority of patients receiving CAPD include 4 or 5 exchanges of dialysis solution with equal short dwell times (4‐5 hours) and 1 long dwell times (duration 8‐9 hours) at night with glucose‐containing solutions. The disadvantages of this mode are: 1) difficulties in the organization of work for the patients; 2) rapid deterioration of the transport properties of the peritoneum. We investigated the influence of the new (adaptive) regime of dialysis (AR PD): two short dwell times (3hours) and two long dwell times (9 hours) on the transport properties of the peritoneum and adequacy treatment. Methods: This study was a randomized, open, prospective, comparative and local. We randomized 90 patients: 45 patients were treated with AR PD and 45 PD patients were receiving SR PD (control group) for 6 months. We measured peritoneal KT/Vurea, volume ultrafiltration (UF), ratio of the concentration of creatinine in the dialysate to its concentration in the blood (D/Pcreat) in the PET test, Na, K, P, Ca in blood and dialysate, removal of sodium through the peritoneum. These parameters were investigated every 3 months. From the 90 randomized patients, 80 patients completed this study. Results: The index of the adequacy ( KT/Vurea) in patients on both regimes are not significantly changed after 3 and 6 months of follow up. The volume of the ultrafiltration in the group on the AR PD remained unchanged, while UF in patients on SR PD was significantly reduced from 1.37 ± 0.5 to 1.21 ± 0,4l (p <0.05) at 6 months. D/Pcreat increased from 0,74 ± 0,04 to 0,78 ± 0,04 (p <0.05) in patients with SR PD after 6 months , but not changed in patients on AR PD. Sodium removal in patients with AR PD was statistically significantly higher (151,9 ± 53,0 mmol/24 h) than in the group on SR PD 88,48 ± 42 mmol / 24h. By 6 months treatment in patients on AR PD systolic and diastolic BP were not significantly changed, whereas in patients on SR PD systolic arterial pressure was significantly increased from 129,1 ± 15,5 to 132,14 ± 14,5 mm Hg (p <0.05). Conclusions: The application of AR PD to reduce the negative effects of glucose‐containing peritoneal dialysis solutions on peritoneum, as evidenced by the absence of changes D/P creat and preservation of ultrafiltration compared to SR PD at 6 months. The highest removal of sodium in patients with AR PD than with SR PD could explain the changes in blood pressure. AR PD allows patients to use daytime (without exchange of dialysis solution) for better rehabilitation.