Automated PD linked to fewer complications, lower costs vs. hemodialysis in some patients
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Key takeaways:
- The rate of dialysis-related complications was lower in the automated peritoneal dialysis group.
- Total direct medical cost of the initial hospitalization was also lower.
Automated peritoneal dialysis may be linked to fewer dialysis-related complications and lower initial hospitalization costs compared with hemodialysis for certain patients, according to published data.
Automated peritoneal dialysis “[APD], a specific form of [peritoneal dialysis] PD, is gaining traction as a viable modality for renal replacement therapy in urgent-start scenarios,” researchers, led by Haijiao Jin, Wei Fang and Ling Wang of the Ren Ji Hospital department of nephrology in Shanghai, China, wrote in a prospective study. “The potential advantages of APD extend beyond mere physiological benefits such as fewer hemodynamic fluctuations and a continuous clearance of solutes; it also offers enhanced patient comfort, making it a favorable choice for patients and medical practitioners alike.”
In a multicenter control trial, researchers evaluated 116 adults with ESKD, from 11 hospitals, who needed urgent dialysis between 2019 and 2020 because of late disease presentation or rapid progression, and did not have prior dialysis access. Patients were randomized to either an automated peritoneal dialysis or hemodialysis group and had 2 weeks of treatment with a central venous catheter before maintenance peritoneal dialysis. Each group had 58 patients, who were followed until 2021.
Researchers found the 1-year incidence of dialysis-related complications was lower in the automated peritoneal dialysis group compared with patients in the hemodialysis group at 25.9% and 56.9%, respectively.
There were no significant differences between in of peritoneal dialysis catheter survival rates, peritonitis-free survival rates or patient survival rates, the researchers found.
Regarding health economics for patients with ESKD, duration of the first hospital stay showed no significant difference between groups, according to the study, but total direct medical cost of the initial visit was lower in the automated peritoneal dialysis group (27,008.39 Chinese yuan) than in the hemodialysis group (42,597.54 Chinese yuan).
Overall, the study suggests automated peritoneal dialysis is a “viable, safe and potentially cost-effective option” to manage urgent-start dialysis, according to the researchers. “These findings can guide clinical decision-making for the optimal dialysis modality for patients requiring urgent dialysis initiation,” they wrote.
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