がん研究と免疫腫瘍学ジャーナル
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概要

Role of Tidal Peritoneal Dialysis in Urgent-start Peritoneal Dialysis

Jia Wen Lai, Charles C.N. Wang, Che-Yi Chou

Background: Despite the proven safety and efficacy of Tidal Peritoneal Dialysis (TPD) in most Urgent-Start Peritoneal Dialysis (USPD) cases, the clinical staffs remains hesitant to implement it. We aimed to examine the usefulness of TPD in USPD patients, identify factors associated with troubleshooting of Automated PD (APD), and assess the clinical staff’s acceptance of TPD.

Method: We reviewed 78 patients with APD for more than three months in Asia university hospital using a baxter claria cycler. We compared biomarkers and troubleshooting events in APD patients treated with Intermittent PD (IPD) and TPD modalities. Blood Urea Nitrogen (BUN), creatinine, potassium, and C-Reactive Protein (CRP) before and 7-day after treatment were analyzed using a t-test. The troubleshooting events, including “low drain volume, “reduced dwell time,” and “end therapy early,” were analyzed using the chi-square test.

Results: This study included 78 PD patients (IPD, n=44; TPD, n=34). Patients’ demographic and clinical parameters did not differ between IPD and TPD groups. We divided the troubleshooting events of APD into three stages: low drain volume, reduced dwell time, and end therapy early procedure. With the IPD modality, 23 (52.3%) patients had low drain volume, 17 (38.6%) patients had reduced dwell time, and 10 (22.7%) were unable to complete the procedure. With the TPD modality, 10 (29.4%) patients had low drain volume, 4 (11.8%) patients had reduced dwell time, and all completed the procedure. We also found that body mass index (BMI) (p=0.005), BUN level (p=0.00), and creatinine level (p=0.000) were significantly correlated with troubleshooting events by APD.

Conclusions: For USPD patients, TPD was associated with reduced troubleshooting events. In particular, patients with high BUN, creatinine levels, and a high BMI may have a higher probability of troubleshooting events. Therefore, their treatment can be changed to the TPD modality, increasing clinical staff acceptance.