Implementation of Personalised Peritoneal Dialysis Strategies and Their Associations With Dialysis Adequacy,...

Peritoneal dialysis is an established kidney replacement therapy for people with kidney failure, allowing home-based treatment, autonomy and preservation of residual kidney function. However, large differences in solute transport, fluid balance and treatment adherence make long-term management difficult. Conventional empiric approaches may not adequately address these variations. This study evaluated the effect of a structured, personalised peritoneal dialysis strategy on dialysis adequacy, volume control, complication rates, and health-related quality of life.

In this single-centre, prospective, randomised controlled trial, 298 people receiving peritoneal dialysis were enroled between January 2018 and January 2025 and randomly assigned (1:1) to an intervention group or a control group (n = 149 each). The intervention programme included prescription stratification guided by the peritoneal equilibration test, monthly bioimpedance analysis for fluid assessment, residual kidney function preservation measures, nutritional support and remote monitoring with alert feedback. The control group received conventional outpatient peritoneal dialysis care. The primary endpoint was weekly Kt/V at 12 months. Secondary endpoints included creatinine clearance, overhydration, rate of residual kidney function decline, peritonitis incidence, hospitalisation, Kidney Disease Quality of Life 36-item instrument scores, and safety.

At 12 months, the intervention group had a higher weekly Kt/V than the control group (1.92 ± 0.34 vs. 1.74 ± 0.36; p = 0.003). The intervention was also associated with improved solute clearance and volume control, slower decline in residual kidney function, lower peritonitis and hospitalisation burden, and better health-related quality of life, without additional safety concerns.

Structured personalised peritoneal dialysis management improves dialysis adequacy, fluid status, and person's well-being, while maintaining safety and feasibility.