Application Of Different Dialysis Models In Dialysis Patients During The Transition Period

Objective: To explore the application of different dialysis models in peritoneal dialysis patients during the transition period,and to provide an appropriate treatment strategy for patients initiate peritoneal dialysis.Methods: We retrospectively recruited 78 patients who were clearly diagnosed as end-stage renal disease,placemented peritoneal dialysis catheters and underwent urgent peritoneal dialysis treatment from October 2013 to October 2016 in the Second Hospital of Jilin University.Before receiving the regular continuous ambulatory peritoneal dialysis(CAPD),all patients went through a 9 days of transition period and the treatment modes included automated peritoneal dialysis(APD)and progressive continuous ambulatory peritoneal dialysis(P-CAPD).According to the treatment strategy during the transition period,patients were divided into three groups: APD-9 group(N = 32,APD treatment for 9 days),APD-6 group(N = 24,APD treatment for 6 days plus progressive CAPD treatment for 3 days)and P-CAPD group(N = 22,progressive CAPD treatment for 9 days).All patients were treated with progressive PD from day 1-3 after operation and the observation period was 9 days.APD-9 treatment stratge: for the first 3 days of the transition period,(650ml × 9cycles × 48 min,dwell overnight);4-6 days(1000ml × 8cycles× 48 min,dwell overnight);7-9 days(1500ml × 6cycles× 84 min,dwell overnight).APD-6 treatment stratge: the treatment of the first 6 days is consistence with the APD-9 group,7-9 days for the CAPD(1500ml × 4cycles × 4h,dwell overnight).P-CAPD group treatment stratge: the first 3 days of the transition(500-800 ml × 4cycles × 3-4h,dwell overnight);4-6 days(1000ml × 4cycles × 3-4h,dwell overnight);7-9 days(1500 × 4cycles × 4h,dwell overnight).The biochemical indexes and the occurrence of various complications were recorded before and after 9 days and 1 month after operation.The data collected were statistically studied.Results: 1.The actual treatment volume of PD solution used in the APD-9 group,APD-6 group and P-CAPD group during the transition period was 68.55 L,59.55 L and 36L-39.6L respectively.The actual consumption volume of PD liquid was 72 L,66L,72 L respectively.The actually consumption volume of PD solution in APD-6 group was the least in the three groups.The actual consumption volume of PD liquid in APD-9 group was same with that in manual group.However,actual treatment volume of PD solution used in the APD-9 group was more than that in P-CAPD group.2.At the end of the transitional treatment,the improvement of the small molecule toxin(creatinine,urea nitrogen)clearance and electrolyte disorder(potassium and phosphorus)were more obvious in the APD-9 and APD-6 groups than those in P-CAPD group(P<0.05).3.At the end of the transitional treatment,the decline of nutritional indicators(albumin,prealbumin)in the APD-9 group was more obvious than that in APD-6 group(P<0.05).However,no significant difference in toxins removal and electrolyte disorders correction was observed(P>0.05).4.No significant difference in the incidence of mechanical complications,peritonitis and catheter-related infection was observed during the transitional period(P>0.05).However,the time of training and education in APD-9 group [(1.68 ± 0.46)h/d] and APD-6 group [(1.52 ± 0.41)h/d] was significantly longer than that in P-CAPD group [(1.27 ± 0.37)h/d](P<0.05).5.After 1 month of follow-up,no significant difference in the three groups in the improvement of toxins removal,electrolyte and nutritional indicators,the decrease of residual renal function and the peritonitis occurrence was observed(P> 0.05).Conclusions: 1.In the transition period,greater volume of PD solution and lower waste rate of PD solution can be obtained by using APD.Thus the effective utilization of PD solution is improved.2.Compared with the traditional progressive CAPD therapy,APD is more effective in uremic toxins clearance and electrolyte disorders correction.Moreover,for patients using APD,the incidence of early complications does not increase and the training time is much longer.3.It is feasible for patients to use APD during the transition period.Compared with sustained 9 days of APD,6 days of APD combining with 3 days of progressive CAPD treatment shows a greater advantage in the reduction of nutritional loss.Therefore,6 days of APD combining with 3 days of progressive CAPD is recommended during the transition period.