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Comparative Study
. 2011 Mar;6(3):537-42.
doi: 10.2215/CJN.00470110. Epub 2011 Mar 10.

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

Wieneke Marleen Michels  1 , Marion Verduijn, Diana C Grootendorst, Saskia le Cessie, Elisabeth Wilhelmina Boeschoten, Friedo Wilhelm Dekker, Raymond Theodorus Krediet; NECOSAD study group
Collaborators, Affiliations
Comparative Study

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

Wieneke Marleen Michels et al. Clin J Am Soc Nephrol. 2011 Mar.

Abstract

Background and objectives: We compared the decline of RRF in patients starting dialysis on APD with those starting on CAPD, because a faster decline on APD has been suggested.

Design, setting, participants, & measurements: NECOSAD patients starting dialysis on APD or CAPD with RRF at baseline were included and followed for 3 years. Residual GFR (rGFR) was the mean of urea and creatinine clearances. Differences in yearly decline of rGFR were estimated in analyses with linear repeated measures models, whereas the risk of complete loss of RRF was estimated by calculating hazard ratios (HRs) for APD compared with CAPD. As-treated (AT) and intention-to-treat (ITT) designs were used. All of the analyses were adjusted for age, gender, comorbidity, and primary kidney disease and stratified according to follow-up and mean baseline GFR.

Results: The 505 CAPD and 78 APD patients had no major baseline differences. No differences were found in the analyses on yearly decline of rGFR. APD patients did have a higher risk of losing RRF in the first year (ITT crude HR 2.43 [confidence interval 95%, 1.48 to 4.00], adjusted 2.66 [1.60 to 4.44]; AT crude 1.89 [1.04 to 3.45], adjusted 2.15 [1.16 to 3.98]). The higher risk of losing all RRF was most pronounced in patients with the highest rGFR at baseline (ITT; crude 3.91 [1.54 to 9.94], adjusted 1.85 to 14.17).

Conclusions: The risk of losing RRF is higher for patients starting dialysis on APD compared with those starting on CAPD, especially in the first year.

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Figures

Figure 1.
Figure 1.
Mean GFR over time. The dashed lines represent the CAPD patients, and the solid lines represent the APD patients.
See this image and copyright information in PMC

References

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