The associations between quality of life and a five-day per week peritoneal dialysis prescription: A pilot randomized controlled study

Abstract

Background

Incremental peritoneal dialysis (PD) has been recommended as a patient-focused prescription; however, its safety and potential clinical benefits are based on retrospective studies.

Methods

We conducted a pilot, randomized controlled study comparing 5-day versus 7-day/week PD in incident patients with preserved residual kidney function in three centers in Australia. Modality of PD accorded to patient and clinician preferences for both groups. Participants on 5-day PD were transitioned to daily PD if symptoms of uremia did not respond to an increase in dialysate volume, or if residual renal creatinine clearance fell to <50 L/week/1.73m². Duration of the 5-day regimen, quality of life, and clinical outcomes were compared to standard treatment over 12 months.

Results

Twenty-four participants were randomized to 7-day (n = 13) or 5-day (n = 11) PD. At baseline, age, gender, diabetes prevalence, and estimated glomerular filtration rate were similar. The mean and median durations of the 5-day prescription were 8.4 ± 4.7 and 12 (IQR 5-12) months, respectively. On average, participants in the 5-day Group had 73 dialysis-free days/person and utilized less PD fluid (957 ± 218 vs. 1558 ± 436 L/person, P < 0.0001). No differences were observed in peritonitis (0.12 vs. 0.26 episodes/patient-year) or hospitalization (0.12 vs. 0.09 episodes/patient-year) rates between 5- and 7-day groups, respectively. Although physical, mental, and kidney-disease composite scores were comparable between groups, sleep quality and patient satisfaction were higher in the 5-day Group.

Conclusion

Incremental PD was feasible in patients with preserved residual kidney function in the first year of dialysis and was not associated with more complications compared with daily PD. Differences observed in sleep quality of treatment satisfaction are hypothesis-generating and warrant further evaluation.