Yunhui Zhang, Hong Wang, Keming Geng, Guifen Chai, Jun Luo
Initial low-dose CAPD and daytime PD were associated with different residual urine-volume trajectories while dialysis adequacy was maintained. No symptom-burden benefit was demonstrated. Given the non-randomized design, baseline imbalance, limited adjustment for treatment selection, and use of urine volume as a surrogate, these findings are exploratory and require prospective confirmation.
BACKGROUND: Residual kidney function influences outcomes and quality of life in peritoneal dialysis (PD), but the optimal initiation strategy remains uncertain.
MATERIALS AND METHODS: We retrospectively studied 120 incident PD patients treated at a tertiary nephrology center in China from February to December 2023. Patients were categorized by initial prescription as low-dose continuous ambulatory PD (CAPD-L), full-dose CAPD (CAPD-F), daytime ambulatory PD (DAPD), or automated full-dose PD (APD-F). Twelve-month outcomes included 24-hour residual urine volume, weekly total Kt/V, nutritional and mineral markers, and documented uremia-related symptoms. Baseline imbalance was assessed using standardized mean differences, and longitudinal changes were analyzed using repeated-measures models with group-by-time interactions. Urine volume was considered a surrogate measure of residual kidney function.
RESULTS: Baseline imbalance was notable, particularly for age and urine volume. At 12 months, mean 24-hour urine volumes were 962.7 ± 198.6, 790.5 ± 210.4, 960.1 ± 180.3, and 945.7 ± 190.2 mL/day in the CAPD-L, CAPD-F, DAPD, and APD-F groups, respectively. The between-group difference was significant (p = 0.006), as was the unadjusted group-by-time interaction (p = 0.003). Weekly total Kt/V remained above 1.7 in all groups. No significant between-group differences were observed in serum albumin or documented uremia-related symptoms at 12 months.
CONCLUSION: Initial low-dose CAPD and daytime PD were associated with different residual urine-volume trajectories while dialysis adequacy was maintained. No symptom-burden benefit was demonstrated. Given the non-randomized design, baseline imbalance, limited adjustment for treatment selection, and use of urine volume as a surrogate, these findings are exploratory and require prospective confirmation.