Decline in residual renal function in automated compared with continuous ambulatory peritoneal dialysis

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Dialysis Modalities

Background:

• Residual renal function (RRF) is crucial for patient outcomes in dialysis.
• Automated peritoneal dialysis (APD) and continuous ambulatory peritoneal dialysis (CAPD) are common dialysis methods.
• Previous suggestions indicated a potentially faster decline of RRF with APD.

Purpose of the Study:

• To compare the decline in residual renal function (RRF) between patients initiating APD versus CAPD.
• To investigate the risk of complete RRF loss in APD versus CAPD patients.

Main Methods:

• A 3-year follow-up study of 583 patients (78 APD, 505 CAPD) from the NECOSAD cohort with baseline RRF.
• Residual glomerular filtration rate (rGFR) calculated as mean urea and creatinine clearances.
• Linear repeated measures models for yearly rGFR decline and hazard ratios for RRF loss, adjusted for covariates.

Main Results:

• No significant difference in the yearly decline of rGFR between APD and CAPD groups.
• APD patients showed a significantly higher risk of losing RRF in the first year (adjusted HR 2.66 for ITT).
• This increased risk of RRF loss was most pronounced in APD patients with the highest baseline rGFR.

Conclusions:

• The risk of losing residual renal function is elevated for patients starting APD compared to CAPD.
• This increased risk is particularly evident within the first year of dialysis initiation.
• Patients with higher baseline residual kidney function may be more susceptible to RRF loss on APD.