Contrasting clinical outcomes between different modes of peritoneal dialysis regimens: two center experiences in...

In the present study, we compared the clinical outcomes between two different modes of peritoneal dialysis (PD) and explored the possible role of volume overload in continuous ambulatory peritoneal dialysis (CAPD) patients. A longitudinal and a cross-sectional study were included. Patients received either an 'adaptative ultrafiltration (UF)' PD regimen, which focused on gradually increasing peritoneal ultrafiltration (PDi group), or traditional PD treatment (PDt group). Patients' demographic characteristics, nutritional status, fluid removal as well as fluid status were recorded. In the cross-sectional study, all clinically stable patients who were treated with CAPD for at least three months were enrolled and grouped according to their time on dialysis: short term, medium term, and long term. Both studies showed that PDi and PDt patients had distinct fluid removal patterns. PDt patients had decreased total fluid removal with worsening fluid status and deteriorating nutritional status, whereas PDi patients remained rather stable in relation to fluid removal, fluid status, and improving nutritional status. Cox regression analysis confirmed that the PDi group had better patient survival than the PDt group. Our data suggest that traditional and 'adaptative UF' PD therapy may have distinct fluid removal patterns over time on dialysis, and this unique pattern might partly explain the still unacceptable high mortality of long-term CAPD patients.