One litre-one hour exchange for acute peritoneal dialysis as a cost effective approach.
OBJECTIVE
To compare the three different protocols i.e. 1-litre 1-hour, 2-litre 1/2 hour and 1-litre 1/2 hour of acute peritoneal dialysis in terms of cost effectiveness and efficacy per one dialysis session.


METHODS
A comparative study.


METHODS
Nephrology Department, Shaikh Zayed Hospital, Lahore, from August 2006 to February 2007.


METHODS
Ninety patients with advanced renal failure underwent acute peritoneal dialysis according to three different protocols: Group 1 undergoing 1-litre 1-hour, Group 2 with 2-litre over 1/2 hour, and Group 3 having 1-litre 1/2 hour, approach, each for 30 patients. Pre- and postdialysis serum urea and creatinine were measured in each patient. Total cost of dialysate used for each treatment session was calculated.


RESULTS
Mean pre-dialysis serum creatinine was 16.18 +/- 5.8, 14.72 +/- 5.9, 15.10 +/- 4.9 for group 1, 2 and 3 respectively. Mean postdialysis serum creatinine was 10.82 +/- 3.8, 8.72 +/- 3.5, 9.51 +/- 3.2 for group 1, 2 and 3 respectively. Mean pre- dialysis blood urea nitrogen (Bun )was 118.07 +/- 42.3, 126.73 +/- 38.8, 101.21 +/- 33.3 for group 1, 2 and 3 respectively. Mean postdialysis blood urea nitrogen was 68.70 +/- 28.8, 54.53 +/- 15.6, 62.83 +/- 22.5 for group 1, 2 and 3 respectively. Delta creatinine change (pre-dialysis creatinine - postdialysis creatinine) was 5.35 +/- 3.1, 5.99 +/- 3.42, 5.52 +/- 2.9 for group 1, 2 and 3 respectively (p =0.719) between the groups. Delta BUN change (pre-dialysis BUN - postdialysis BUN) was 49.37 +/- 22.2, 72.20 +/- 31.2, 39.40 +/- 21 for group 1, 2 and 3 respectively (p=0.00001). Average number of exchanges per treatment was 34 +/- 2, 44 +/- 2, and 43 +/- 2.5 for group 1, 2 and 3 respectively. Total cost per treatment session was Rs. 1368 +/- 87.5, Rs. 3458 +/- 371.8, and Rs. 1725 +/- 98 respectively (p< value 0.000).


CONCLUSIONS
Urea reduction was better and statistically significant with 2-litre 1/2 hour protocol, while there was no difference in creatinine reduction among three groups.This higher urea reduction with 2-litre -1/2 hour protocol was at the expense of 2.4 times extra cost, therefore, 1-litre 1-hour protocol was more cost effective.
Department of Nephrology, Shaikh Zayed Hospital, Lahore.
Ghulam
G
Abbas
Tahir
T
Shafi