Comparing The Influence Of Automated Peritoneal Dialysis And Continuous Ambulatory Peritoneal Dialysis On Residual Renal Function

BackgroundResidual renal function is associated with mortality and quality of life in ESRD patients.However,there is controversy concerning the impact of automated peritoneal dialysis(APD)and continuous ambulatory peritoneal dialysis(CAPD)on RRF in end stage renal disease(ESRD)patients.ObjectivesWe conducted a retrospective cohort study to investigate whether there are the differences between APD and CAPD in the decline rate of RRF,the risks of loss of RRF(<1ml/min)and anuria(<100ml)in ESRD patients.And a meta-analysis was conducted to further clarify the effect of APD on RRF.Methods1.A total of 205 patients who began peritoneal dialysis in Zhujiang Hospital of Southern Medical University from 2015 to 2019 were selected for the study,Logistic regression analysis was performed to explore variables associated with faster decline of RRF.And Cox regression analysis was performed to detect variables associated with increased risk of loss of RRF or anuria.2.The relevant literatures were searched from Pubmed,EMBASE,Cochrane and Web of Science from inception to December 30,2019.After screening,extracting relevant data and evaluate the risk of bias of included studies,meta-analysis was conducted by RevMan5.3 software.Results1.Patients started on APD had higher levels of diastolic blood pressure,mean arterial pressure than those on CAPD(P<0.05).There was no significant difference in baseline RRF and urine volume between APD group and CAPD group(P>0.05).During the follow-up period,the average ultrafiltration and total creatinine clearance of CAPD group were higher than those of APD group(p=0.014,p=0.008).The proportion of high and high average peritoneal transport characteristics in CAPD group was higher than that in APD group(p=0.002).The median decline rate of RRF was-0.087ml/min/1.73m2/month.The factors associated with rapid decline of RRF in logistic regression analysis included APD,male,diabetes,higher baseline RRF,higher baseline urine volume,higher ultrafiltration and peritoneal Kt/V.73 patients had occurred loss of RRF and 54 had occurred anuria.Cox regression analysis showed that APD,diabetes,the use of ACEI/ARB,higher ultrafiltration and peritoneal Kt/V,high peritoneal transport characteristic were associated with increased risks of loss of RRF and anuria.Male was associated with increased risks of anuria.2.11 cohort studies were included in meta analysis.RRF end of study in APD group was lower than CAPD group(n=1311,SMD=-0.16,95%CI:-0.28-0.04,P=0.008).The decline rate of RRF was similar in APD and CAPD(n=1752,SMD=0.08,95%CI:-0.003-0.18,P=0.14).APD had a higher risk of anuria than CAPD(n=1322,RR=2.10,95%CI:1.17-3.77,P=0.14).In subgroup analysis,within the first year,RRF end of study in APD group was lower than that in CAPD group(n=397,SMD=-0.29,95%CI:-0.51--0.07,P=0.009),but there was no statistical difference after the first year(n=914,SMD=-0.11,95%CI:-0.25-0.03,P=0.14).ConclusionsAPD was associated with an increased risk of loss of RRF in incident PD patients.Meta-analysis further supported that APD had a deleterious effect on RRF.