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Kidney Week

Abstract: SA-PO741

Peritoneal Dialysis Modalities Portend Distinct Decongestive Properties

Session Information

  • Peritoneal Dialysis - II
    November 04, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Dialysis

  • 608 Peritoneal Dialysis

Authors

  • Koratala, Abhilash, University of Florida, Gainesville, Florida, United States
  • Olaoye, Olanrewaju Adebayo, University of Florida, Gainesville, Florida, United States
  • Kazory, Amir, University of Florida, Gainesville, Florida, United States
Background

Previous studies have established the adverse impact of lingering fluid overload on the outcomes of patients with ESRD treated with peritoneal dialysis (PD). There is mounting evidence that decongestion, if not associated with significant sodium removal, does not improve the outcomes in specific subsets of patients such as those with heart failure. We sought to explore available evidence on the ability of the two main modalities of PD (i.e. continuous ambulatory PD [CAPD] and automated PD [APD]) with regard to sodium removal.

Methods

Articles cited in PubMed database from January 2000 to March 2017 using key words “peritoneal dialysis”, “sodium removal”, and “ultrafiltration” were searched. Articles evaluating sodium extraction and ultrafiltration (UF) were reviewed. Clinical trials on comparative impacts of CAPD and APD were selected. Relevant data including urine volume, UF volume, and sodium removal were extracted and compared. Using Pearson product-moment correlation, the degree of linear dependence between sodium removal and UF was determined.

Results

A total of 76 citations were reviewed and 7 studies with 654 participants were included. The mean age was 55.7 years and 55.9% were men. The mean PD sodium removal was 142±44 and 87±23 mmol/day for CAPD and APD respectively (p=0.006). There was no difference between urine sodium excretion between the two groups (42.4±25 and 39.9±21 mmol/day for CAPD and APD respectively, p=0.42). The mean UF volume was 1133±331 and 931±210 mmol/day for CAPD and APD (p=0.09). There was a strong correlation observed between PD sodium removal and UF volume for CAPD (r=0.99, p=0.0) while it was only modest for APD (r=0.6, p=0.15).

Conclusion

Currently available evidence suggests that fluid removal is comparable for CAPD and APD. However, CAPD is associated with significantly greater sodium extraction compared to APD, with strong correlation between UF volume and the amount of sodium removal. Therefore, it is conceivable that CAPD would be advantageous in clinical settings such as heart failure where sodium removal per se is of utmost importance. Future prospective studies are needed to explore whether the advantageous sodium extraction by CAPD would translate into improved outcomes in these patients.