Retrospective analysis of the effects of peritoneal dialysis modes, initial doses, and frequencies on residual renal function and quality of life in patients initiating peritoneal dialysis.

BACKGROUND

Residual kidney function influences outcomes and quality of life in peritoneal dialysis (PD), but the optimal initiation strategy remains uncertain.

MATERIALS AND

METHODS

We retrospectively studied 120 incident PD patients treated at a tertiary nephrology center in China from February to December 2023. Patients were categorized by initial prescription as low-dose continuous ambulatory PD (CAPD-L), full-dose CAPD (CAPD-F), daytime ambulatory PD (DAPD), or automated full-dose PD (APD-F). Twelve-month outcomes included 24-hour residual urine volume, weekly total Kt/V, nutritional and mineral markers, and documented uremia-related symptoms. Baseline imbalance was assessed using standardized mean differences, and longitudinal changes were analyzed using repeated-measures models with group-by-time interactions. Urine volume was considered a surrogate measure of residual kidney function.

RESULTS

Baseline imbalance was notable, particularly for age and urine volume. At 12 months, mean 24-hour urine volumes were 962.7 ± 198.6, 790.5 ± 210.4, 960.1 ± 180.3, and 945.7 ± 190.2 mL/day in the CAPD-L, CAPD-F, DAPD, and APD-F groups, respectively. The between-group difference was significant (p = 0.006), as was the unadjusted group-by-time interaction (p = 0.003). Weekly total Kt/V remained above 1.7 in all groups. No significant between-group differences were observed in serum albumin or documented uremia-related symptoms at 12 months.

CONCLUSION

Initial low-dose CAPD and daytime PD were associated with different residual urine-volume trajectories while dialysis adequacy was maintained. No symptom-burden benefit was demonstrated. Given the non-randomized design, baseline imbalance, limited adjustment for treatment selection, and use of urine volume as a surrogate, these findings are exploratory and require prospective confirmation.