One litre-one hour exchange for acute peritoneal dialysis as a cost effective approach

To compare the three different protocols i.e. 1-litre 1-hour, 2-litre 1/2 hour and 1-litre 1/2 hour of acute peritoneal dialysis in terms of cost effectiveness and efficacy per one dialysis session.

A comparative study.

Nephrology Department, Shaikh Zayed Hospital, Lahore, from August 2006 to February 2007.

Ninety patients with advanced renal failure underwent acute peritoneal dialysis according to three different protocols: Group 1 undergoing 1-litre 1-hour, Group 2 with 2-litre over 1/2 hour, and Group 3 having 1-litre 1/2 hour, approach, each for 30 patients. Pre- and postdialysis serum urea and creatinine were measured in each patient. Total cost of dialysate used for each treatment session was calculated.

Mean pre-dialysis serum creatinine was 16.18 +/- 5.8, 14.72 +/- 5.9, 15.10 +/- 4.9 for group 1, 2 and 3 respectively. Mean postdialysis serum creatinine was 10.82 +/- 3.8, 8.72 +/- 3.5, 9.51 +/- 3.2 for group 1, 2 and 3 respectively. Mean pre- dialysis blood urea nitrogen (Bun )was 118.07 +/- 42.3, 126.73 +/- 38.8, 101.21 +/- 33.3 for group 1, 2 and 3 respectively. Mean postdialysis blood urea nitrogen was 68.70 +/- 28.8, 54.53 +/- 15.6, 62.83 +/- 22.5 for group 1, 2 and 3 respectively. Delta creatinine change (pre-dialysis creatinine - postdialysis creatinine) was 5.35 +/- 3.1, 5.99 +/- 3.42, 5.52 +/- 2.9 for group 1, 2 and 3 respectively (p =0.719) between the groups. Delta BUN change (pre-dialysis BUN - postdialysis BUN) was 49.37 +/- 22.2, 72.20 +/- 31.2, 39.40 +/- 21 for group 1, 2 and 3 respectively (p=0.00001). Average number of exchanges per treatment was 34 +/- 2, 44 +/- 2, and 43 +/- 2.5 for group 1, 2 and 3 respectively. Total cost per treatment session was Rs. 1368 +/- 87.5, Rs. 3458 +/- 371.8, and Rs. 1725 +/- 98 respectively (p< value 0.000).

Urea reduction was better and statistically significant with 2-litre 1/2 hour protocol, while there was no difference in creatinine reduction among three groups.This higher urea reduction with 2-litre -1/2 hour protocol was at the expense of 2.4 times extra cost, therefore, 1-litre 1-hour protocol was more cost effective.