A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD
Introduction: Peritoneal dialysis (PD) shows promise for urgent-start dialysis in end-stage renal disease (ESRD), with automated PD (APD) having advantages. However, there is limited multicenter randomized controlled trial (RCT) evidence comparing APD with temporary hemodialysis (HD) for this indica...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-09-01
|
| Series: | Kidney International Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2468024924018096 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849336061752246272 |
|---|---|
| author | Haijiao Jin Wei Fang Ling Wang Xiujuan Zang Yueyi Deng Guoqing Wu Ying Li Xiaonong Chen Niansong Wang Gengru Jiang Zhiyong Guo Xiaoxia Wang Yinghui Qi Shifan Lv Zhaohui Ni |
| author_facet | Haijiao Jin Wei Fang Ling Wang Xiujuan Zang Yueyi Deng Guoqing Wu Ying Li Xiaonong Chen Niansong Wang Gengru Jiang Zhiyong Guo Xiaoxia Wang Yinghui Qi Shifan Lv Zhaohui Ni |
| author_sort | Haijiao Jin |
| collection | DOAJ |
| description | Introduction: Peritoneal dialysis (PD) shows promise for urgent-start dialysis in end-stage renal disease (ESRD), with automated PD (APD) having advantages. However, there is limited multicenter randomized controlled trial (RCT) evidence comparing APD with temporary hemodialysis (HD) for this indication in China. Methods: This multicenter RCT enrolled 116 patients with ESRD requiring urgent dialysis from 11 hospitals, randomized to APD or HD. Patients underwent a 2-week treatment with APD or HD via a temporary central venous catheter (CVC), followed by a maintenance PD. Outcomes were assessed over 12 months during 8 visits. The primary outcome was dialysis-related complications. Results: The 1-year incidence of dialysis-related complications was significantly lower in the APD group than in the HD group (25.9% vs. 56.9%, P = 0.001). No significant differences were found between the groups in terms of PD catheter survival rates (P = 0.388), peritonitis-free survival rates (P = 0.335), and patient survival rates (P = 0.329). In terms of health economics, the total direct medical cost of the initial hospitalization for patients with ESRD was significantly lower in the APD group (27,008.39 CNY) than in the HD group (42,597.54 CNY) (P = 0.001), whereas the duration of the first hospital stay showed no significant difference (P = 0.424). Conclusion: For patients with ESRD needing urgent initiation of dialysis, APD was associated with a lower incidence of dialysis-related complications and lower initial hospitalization costs compared with HD, with no significant differences in PD catheter survival rate, peritonitis-free survival rates, or patient survival rates. These findings can guide clinical decision-making for the optimal dialysis modality for patients requiring urgent dialysis initiation. |
| format | Article |
| id | doaj-art-9aa55353be414dbbaa507f6273f6d9ff |
| institution | Kabale University |
| issn | 2468-0249 |
| language | English |
| publishDate | 2024-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Kidney International Reports |
| spelling | doaj-art-9aa55353be414dbbaa507f6273f6d9ff2025-08-20T03:45:06ZengElsevierKidney International Reports2468-02492024-09-01992627263410.1016/j.ekir.2024.06.032A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRDHaijiao Jin0Wei Fang1Ling Wang2Xiujuan Zang3Yueyi Deng4Guoqing Wu5Ying Li6Xiaonong Chen7Niansong Wang8Gengru Jiang9Zhiyong Guo10Xiaoxia Wang11Yinghui Qi12Shifan Lv13Zhaohui Ni14Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Molecular Cell Laboratory for Kidney Disease, Shanghai, China; Shanghai Peritoneal Dialysis Research Center, Shanghai, China; Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Molecular Cell Laboratory for Kidney Disease, Shanghai, China; Shanghai Peritoneal Dialysis Research Center, Shanghai, China; Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Molecular Cell Laboratory for Kidney Disease, Shanghai, China; Shanghai Peritoneal Dialysis Research Center, Shanghai, China; Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Nephrology, Shanghai Songjiang District Central Hospital, Shanghai, ChinaDepartment of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, ChinaDepartment of Nephrology, Affiliated Hospital of Jiangxi University of Traditional Chinese Medicine, Nanchang ChinaDepartment of Nephrology, Central Hospital of Shanghai Jiading District, Shanghai, ChinaDepartment of Nephrology, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Nephrology, Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Nephrology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Nephrology, Changhai Hospital, Naval Medical University, Shanghai, ChinaDepartment of Nephrology, Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Nephrology, Shanghai Punan Hospital, Shanghai, ChinaDepartment of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Molecular Cell Laboratory for Kidney Disease, Shanghai, China; Shanghai Peritoneal Dialysis Research Center, Shanghai, China; Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Molecular Cell Laboratory for Kidney Disease, Shanghai, China; Shanghai Peritoneal Dialysis Research Center, Shanghai, China; Uremia Diagnosis and Treatment Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Correspondence: Zhaohui Ni, Department of Nephrology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, No. 160, Pujian Road, Shanghai 200127, China.Introduction: Peritoneal dialysis (PD) shows promise for urgent-start dialysis in end-stage renal disease (ESRD), with automated PD (APD) having advantages. However, there is limited multicenter randomized controlled trial (RCT) evidence comparing APD with temporary hemodialysis (HD) for this indication in China. Methods: This multicenter RCT enrolled 116 patients with ESRD requiring urgent dialysis from 11 hospitals, randomized to APD or HD. Patients underwent a 2-week treatment with APD or HD via a temporary central venous catheter (CVC), followed by a maintenance PD. Outcomes were assessed over 12 months during 8 visits. The primary outcome was dialysis-related complications. Results: The 1-year incidence of dialysis-related complications was significantly lower in the APD group than in the HD group (25.9% vs. 56.9%, P = 0.001). No significant differences were found between the groups in terms of PD catheter survival rates (P = 0.388), peritonitis-free survival rates (P = 0.335), and patient survival rates (P = 0.329). In terms of health economics, the total direct medical cost of the initial hospitalization for patients with ESRD was significantly lower in the APD group (27,008.39 CNY) than in the HD group (42,597.54 CNY) (P = 0.001), whereas the duration of the first hospital stay showed no significant difference (P = 0.424). Conclusion: For patients with ESRD needing urgent initiation of dialysis, APD was associated with a lower incidence of dialysis-related complications and lower initial hospitalization costs compared with HD, with no significant differences in PD catheter survival rate, peritonitis-free survival rates, or patient survival rates. These findings can guide clinical decision-making for the optimal dialysis modality for patients requiring urgent dialysis initiation.http://www.sciencedirect.com/science/article/pii/S2468024924018096automated peritoneal dialysisend-stage renal diseasehemodialysisurgent-start peritoneal dialysis |
| spellingShingle | Haijiao Jin Wei Fang Ling Wang Xiujuan Zang Yueyi Deng Guoqing Wu Ying Li Xiaonong Chen Niansong Wang Gengru Jiang Zhiyong Guo Xiaoxia Wang Yinghui Qi Shifan Lv Zhaohui Ni A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD Kidney International Reports automated peritoneal dialysis end-stage renal disease hemodialysis urgent-start peritoneal dialysis |
| title | A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD |
| title_full | A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD |
| title_fullStr | A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD |
| title_full_unstemmed | A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD |
| title_short | A Randomized Controlled Trial Comparing Automated Peritoneal Dialysis and Hemodialysis for Urgent-Start Dialysis in ESRD |
| title_sort | randomized controlled trial comparing automated peritoneal dialysis and hemodialysis for urgent start dialysis in esrd |
| topic | automated peritoneal dialysis end-stage renal disease hemodialysis urgent-start peritoneal dialysis |
| url | http://www.sciencedirect.com/science/article/pii/S2468024924018096 |
| work_keys_str_mv | AT haijiaojin arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT weifang arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT lingwang arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT xiujuanzang arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT yueyideng arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT guoqingwu arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT yingli arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT xiaonongchen arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT niansongwang arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT gengrujiang arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT zhiyongguo arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT xiaoxiawang arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT yinghuiqi arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT shifanlv arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT zhaohuini arandomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT haijiaojin randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT weifang randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT lingwang randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT xiujuanzang randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT yueyideng randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT guoqingwu randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT yingli randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT xiaonongchen randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT niansongwang randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT gengrujiang randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT zhiyongguo randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT xiaoxiawang randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT yinghuiqi randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT shifanlv randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd AT zhaohuini randomizedcontrolledtrialcomparingautomatedperitonealdialysisandhemodialysisforurgentstartdialysisinesrd |