Biochemical Parameters, Nutritional Status and Efficiency of Dialysis in CAPD and CCPD Patients

Abstract

Background/Aims: Several studies indicate that small solute transport is influenced by peritoneal dialysate volume and dwell time. This study focuses on the clinical impact of peritoneal dialysis modality, continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD). Methods: We studied 18 patients on CAPD and 11 on CCPD for 18 months and assessed biochemical parameters, nutritional status and efficiency of dialysis at 6-month intervals. Results: Four-hour D/P urea and creatinine ratios were similar in both CAPD and CCPD patients. However, 24-hour D/P urea and creatinine ratios were significantly higher in CAPD than in CCPD patients (0.9 ± 0.1 vs. 0.8 ± 0.2 and 0.8 ± 0.1 vs. 0.6 ± 0.2, p < 0.05 and p < 0.01, respectively). The dialysate urea nitrogen concentration was significantly different between the two groups (65 ± 14 mg/dl in CAPD, 48 ± 13 mg/dl in CCPD; p < 0.05). Total weekly Kt/V and total weekly creatinine clearance were not significantly different between CAPD and CCPD patients at 18 months (1.6 ± 0.4 vs. 1.7 ± 0.3 and 52 ± 21 vs. 50 ± 12 liters, respectively). Two-way ANOVA with a post-hoc Bonferroni-Dunn test showed serum potassium concentration was significantly lower in CCPD patients at 18 months (3.8 ± 0.5 mEq/l, p < 0.05), and significant increases in triglyceride levels in the CAPD groups by 18 months (301 ± 286 mg/dl, p < 0.05). Conclusion: This study demonstrates that the mean serum triglyceride level increases in CAPD patients over time, and the mean serum potassium concentration decreases in CCPD patients at 18 months. Dialysis adequacy and nutritional status are not significantly different between the two peritoneal dialysis modalities, CAPD and CCPD. We suggest the peritoneal dialysis prescription for CAPD or CCPD with respect to volume and frequency of exchanges be individualized to achieve adequate of therapy.

Serum Potassium Levels and Its Variability in Incident Peritoneal Dialysis Patients: Associations with Mortality

“…Given that peritoneal dialysate is potassium-free, ongoing losses of potassium into dialysate may contribute to hypokalemia in some patients. Our results were in accordance with previous studies [24], [25], revealing that an elevated dialysis dose was independently related to decreased serum potassium levels. In addition, potassium redistribution into the intracellular compartment, stimulated by insulin release due to continuous peritoneal glucose infusion was thought to be another important risk factor for hypokalemia [23].…”

Peritoneal Sodium Mass Removal in Continuous Ambulatory Peritoneal Dialysis and Automated Peritoneal Dialysis: Influence on Blood Pressure Control

“…Some investigators [10] observed that high-dose CCPD is better than CAPD concerning ultrafiltration and urea clearances, while others [11][12][13] could not demonstrate statistically significant differences in the weekly urea Kt/V and creatinine clearance between CAPD and APD patients. Our study did not find any difference in adequacy parameters in terms of small-solute clearances between groups, but net ultrafiltration and peritoneal sodium removal were higher in our CAPD patients.…”

Potassium metabolism in patients with chronic kidney disease. Part II: Patients on dialysis (stage 5)

“…Since CCPD uses a greater number of exchanges with shorter dwell times and does not allow for equilibration to occur, there is always a concentration gradient difference between the dialysate and the plasma allowing more potassium to be transported into the dialysate fluid. It has also been shown that patients treated with CCPD tend to have more gastrointestinal symptoms, which may result in a decreased potassium intake [21].…”