Rapid initiation of peritoneal dialysis by automated peritoneal dialysis or hemodialysis: a randomized clinical trial

Introduction: It is still controversial whether automated peritoneal dialysis (APD) or hemodialysis (HD) is a more favorable choice for the rapid initiation of peritoneal dialysis. Methods: A pilot randomized prospective controlled trial was carried out in Shanghai Ruijin Hospital. Sixty-seven patients who chose long-term peritoneal dialysis treatment and needed unplanned dialysis were enrolled and randomized into HD-CAPD group (33 cases) or APD-CAPD group (34 cases) based on the dialysis modality during the transition period (within 14 days from the day PD catheter was implanted). Continuous ambulatory peritoneal dialysis started after the transition period. The primary outcome was the decline rates of residual glomerular filtration rate (GFR). Secondary outcomes included the rates of mechanical complications, the rates of infectious complications and complications of ESRD. Results: We found residual GFR decline were faster in HD-CAPD group than in APD-CAPD group (0.06 ml/min/w vs 0.03ml/min/w, P<0.01). The incidences of mechanical complications were similar in APD-CAPD group comparing with HD-CAPD group, including hernia (2.9% vs 3.0%, P=1.00), catheter malposition (0.02 episodes/patient-months vs 0.02 episodes/patient-months, P=0.70), leakage (5.9% vs 6.1%, P=1.00) and omental wrap (0 episode vs 3 episodes, P=0.368). Though the one-year overall infection rates were similar (0.03 episodes/patient-months vs 0.05 episodes/patient-months, P=0.10), APD-CAPD group had lower rate of bacteremia compared to HD-CAPD group (0 episodes/patient-months vs 0.02 episodes/patient-months, P<0.01). Conclusions: Both APD and HD could be used for patients who need to start dialysis in an unplanned manner. APD may have the advantage in protecting residual renal functions among these patients.