Lower-Dosage Acute Peritoneal Dialysis versus Acute Intermittent Hemodialysis in Acute Kidney Injury

Author:

Parapiboon Watanyu1ORCID,Tatiyanupanwong Sajja2,Khositrangsikun Kamol3,Phulkerd Thanawat4ORCID,Kaewdoungtien Piyanut5ORCID,Pichitporn Watthikorn1ORCID,Lumlertgul Nuttha67ORCID,Peerapornratana Sadudee678,Chen Fangyue9ORCID,Srisawat Nattachai67910ORCID

Affiliation:

1. Maharat Nakhon Ratchasima Hospital, Nakhon Ratchasima, Thailand

2. Chaiyaphum Hospital, Chaiyaphum, Thailand

3. Maharaj Nakhon Si Thammarat Hospital, Nakhon Si Thammarat, Thailand

4. Uttaradit Hospital, Utaradit, Thailand

5. Police General Hospital, Bangkok, Thailand

6. Division of Nephrology, Department of Medicine, Faculty of Medicine, and Center of Excellence in Critical Care Nephrology, Chulalongkorn University, Bangkok, Thailand

7. Excellence Center for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand

8. Department of Laboratory Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

9. Thailand Public Health Research Fellowship, Health Education England, United Kingdom and School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom

10. Academy of Science, Royal Society of Thailand, Bangkok, Thailand

Abstract

Key Points The efficacy of acute peritoneal dialysis is still controversial.There was no significant difference in 28-day mortality between acute peritoneal dialysis and intermittent hemodialysis. Background Lower delivered dose of acute peritoneal dialysis (PD) in AKI requires less resources but raises concerns regarding adequate solute and water clearance. The relative merits of lower-dose PD versus intermittent hemodialysis remain uncertain. Methods A multicenter randomized controlled trial compared the outcomes between acute lower-dosage PD (18–24 L per day) and intermittent hemodialysis (three times per week) from May 2018 to January 2021 in patients with AKI. The primary outcome was 28-day mortality rate. Secondary outcomes included 28-day dialysis-free survival and kidney recovery, metabolic profile, and procedure-related complications. Noninferiority of PD to hemodialysis would be demonstrated if the upper bound of the 95% confidence interval ( CI) on risk difference (PD-hemodialysis) in 28-day mortality rates between the two groups was <20%. Results We included 157 patients (80 allocated to PD and 77 to intermittent hemodialysis). Before KRT initiation, baseline clinical characteristics between groups were comparable. The overall mean age was 57±15 years. The most frequent cause of AKI was sepsis (68%). There was no difference in 28-day mortality between acute PD and intermittent hemodialysis (50% versus 49%, risk difference 0.6 [95% CI, −15.0 to 16.3]), and 28-day dialysis-free survival (42% versus 37%, risk difference 4.6 [95% CI, −11.1 to 20.3]). Mean weekly Kt/V urea was 2.11±1.14 and 2.55±1.11 in the PD and intermittent hemodialysis groups, respectively. The 7-day fluid balance of PD and intermittent hemodialysis patients was not significantly different. There was more frequent intradialytic hypotension in the intermittent hemodialysis group and more frequent hypokalemia in the PD group. Conclusions In this study of patients with AKI, there was no significant difference in 28-day mortality between acute PD and intermittent hemodialysis.

Funder

King Chulalongkorn Memorial Hospital

Publisher

Ovid Technologies (Wolters Kluwer Health)

Reference28 articles.

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2. The burden of acute kidney injury and related financial issues;Ostermann;Contrib Nephrol.,2018

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4. Use of peritoneal dialysis in AKI: a systematic review;Chionh;Clin J Am Soc Nephrol.,2013

5. The use of peritoneal dialysis in heart failure: a systematic review;Chionh;Perit Dial Int.,2020

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Re-Examining Acute Peritoneal Dialysis;Clinical Journal of the American Society of Nephrology;2024-07-16

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