Early-start vs. conventional-start peritoneal dialysis in AKI from cardiorenal syndrome type 1: a randomized...

Peritoneal dialysis (PD) is a feasible option for acute kidney injury (AKI) in hemodynamically unstable patients. However, the optimal timing for initiating PD in cardiorenal syndrome type 1 (CRS1) remains unclear.

In a cardiac care unit of a tertiary hospital in Thailand, CRS1 patients who had AKI stage II between October 2020 and September 2021 were enrolled in a randomized, open-label controlled study. Patients were randomized into two groups: early-start PD strategy (starting PD within 24 h after AKI stage II) and conventional-start PD strategy (starting PD at 72 h if reaching AKI stage III or with an indication). The primary outcome was 30-day mortality. Secondary outcomes included fluid balance, sodium removal during the first 5 days, and PD safety.

77 CRS1 patients were enrolled, and 53 eligible participants were included in a modified intention-to-treat analysis (26 in the early-start group and 27 in the conventional-start group). Dialysis was initiated in 26 patients (100%) in the early-start group and 11 patients (40%) in the conventional-start group. The 30-day mortality was 65% (17 patients) in the early-start group and 40% (11 patients) in the conventional-start group (relative risk 1.68; 95% confidence interval 0.92-3.07; p = 0.07). The first 5-day fluid balance and sodium removal were comparable between the two groups. PD-related complications occurred in 6 events (early-start) and 3 events (conventional-start).

Among CRS1 patients with AKI, early-start and conventional-start PD showed comparable 30-day mortality risk (Thai Clinical Trial Registry number, TCTR20200928003).