Abstract
Efficacy of Low-Dose Daytime Ambulatory Peritoneal Dialysis in Diabetic End-Stage Renal Disease Patients with Better Residual Renal Function
Objective: To prospectively compare the efficacy of low-dose daytime ambulatory peritoneal dialysis (DAPD) and standard-dose continuous ambulatory peritoneal dialysis (CAPD) in diabetic end-stage renal failure (ESRD) patients with better residual renal function (RRF).
Methods: We randomly divided 35 stable diabetic ESRD patients with a dialysis duration of ≥ 3 months and better RRF [estimated glomerular filtration rate (eGFR) ≥ 5 mL/min–11.73 m–2 (MDRD formula); urine volume ≥ 750 mL/d] into two groups: low-dose DAPD (group A: n = 18, 64 ± 14 years) and standard-dose CAPD (group B: n = 17, 65 ± 12 years). Group A received 3×1.5-L or2-L daily exchanges, 3 – 4 hours’ dwell time, and no overnight dialysis dwell. Group B received 4×2-L daily exchanges. All patients were followed for 6 months. Adequacy of PD and peritoneal characteristics were assessed by weekly Kt/V and total creatinine clearance (tCCr), dialysate-to-plasma creatinine (D/P Cr) at the start and after 6 months of treatment. We also measured 24-hour urinary protein, serum albumin (Alb), hemoglobin, fasting plasma glucose, and HbA1c, and at the same time obtained scores for subjective global assessment (SGA) of nutrition status and quality of life (QOL) as measured by the Short Form 36 health survey questionnaire.
Results: There was no statistical difference between two groups in age, sex, body mass index (BMI), 24-hour urinary protein, Alb, weekly Kt/V and tCCr, D/P Cr, RRF, and insulin dose. At the end of follow-up, the incidence of peritonitis was similar between group A and group B (1/18 and 1/17 respectively), and the total weekly Kt/V, tCCr, 24-hour urinary protein, Alb, and SGA scores between the two groups were not statistically different. The RRF in group A was better than that in group B (10.21 ± 2.4 mL/min–11.73 m-2 vs. 7.18±2.1 mL/min–11.73 m-2, p < 0.05). The increase in insulin dose was less in group A than in group B (p < 0.05), and QOL scores increased significantly only in group A (p < 0.05).
Conclusions: For diabetic ESRD patients with better RRF, low-dose DAPD is more effective than standard-dose CAPD at protecting RRF, controlling diabetes, and improving QOL.