The Effect of Hemodialysis During Break-in Period on Residual Renal Function in CAPD Patients / 대한신장학회잡지

ABSTRACT

To avoid later complication of peritoneal dialysis catheter, it is recommended to delay regular exchange of peritoneal dialysis for about 2-4weeks after insertion of catheter(break-in period). During break-in period some patients need hemodialysis(HD) or other intermittent dialysis. In such cases residual renal function(RRF) can decrease substantially compared with patients who do not need HD during break-in period since RRF is preserved better in CAPD patients than HD patients. This is prospective observational study to examine such an effect of HD during break-in period on residual renal function in CAPD patients. 20 patients who were clinically stable and had been on CAPD since March, 1999 were observed. 6 patients were treated with HD for 1month during break-in period and CAPD thereafter(group A). 14 patients were treated with CAPD without HD(group B). GFR(mean of creatinine and urea clearance of urine) and urine Kt/V urea were measured at start, and 1, 3, 6 months of renal replacement therapy. Covariables analyzed in this study were mean arterial blood pressure, serum albumin, hemoglobin, hematocrit, age, sex, the presence of diabetes mellitus, and peritonitis episode. There was no significant difference in initial RRF, mean arterial blood pressure, serum albumin, hemoglobin, hematocrit, age, sex, and the presence of diabetes mellitus between 2 groups. Initial GFR was a little smaller in group A than group B(45.0+/-10.1 L/week vs. 54.6+/-5.7L/week) which was not statistically significant. GFR after 1, 3 and 6months of dialysis(including 1month of HD in group A) were smaller in group A than B(28.6+/-5.3L/week vs. 54.4+/-5.7L/week, 32.7+/-5.2L/week vs 56.9+/-6.1L/week, 21.0+/-4.1L/week vs 53.6+/-5.4L/week at 1,3,6 months after dialysis in group A and B), which were significant. Urine Kt/V showed same pattern. The change of GFR and urine Kt/V have no correlation with serum albumin, hemoglobin, hematocrit, and change of mean arterial blood pressure and is not affected by sex, and presence of DM or peritonitis. We concluded that HD during break-in period can decrease RRF in CAPD patients, which may not recover after 6months of dialysis. Avoiding HD during break-in period with appropriate preparation can preserve RRF in CAPD patients.