Comparison of volume overload with cycler-assisted versus continuous ambulatory peritoneal dialysis.
OBJECTIVE
Cycler-assisted peritoneal dialysis (CCPD) has been associated with decreased sodium removal compared with continuous ambulatory peritoneal dialysis (CAPD) as a result of peritoneal sodium sieving during the short dwells that are associated with CCPD. This may have adverse consequences for management of extracellular fluid volume (ECFV). This study compared ECFV in patients who received CAPD or CCPD; CCPD dwell times were maximized by limiting the number of exchanges, and the use of icodextrin for the long daytime dwells was widespread.


METHODS
This was an observational, cross-sectional study of 158 prevalent patients (90 CAPD, 68 CCPD). Demographic data, blood work, and 24-h dialysate and urine samples were collected from all participants between January 2004 and July 2006. They subsequently underwent assessment of ECFV by multifrequency bioimpedance spectroscopy analysis. Multivariate analysis was used to determine the relationship between peritoneal dialysis modality and ECFV. Potential cofounders including age, comorbidity, time on dialysis, residual renal function, and icodextrin use were identified a priori.


RESULTS
There were no differences in BP, use of antihypertensive medications, or the presence of peripheral edema between CAPD and CCPD patients. Similarly, there was no difference in the ratio of ECFV to total body water between CAPD (51.8%) and CCPD (51.9%) patients (P = 0.929).


CONCLUSIONS
There is no difference in BP, sodium removal, or volume control in patients who use a contemporary approach to CCPD that uses fewer night cycles and liberalizes the use of icodextrin when compared with CAPD.
Davison
Sara N
SN
Division of Nephrology, University of Alberta, Alberta, Canada. sara.davison@ualberta.ca
Jhangri
Gian S
GS
Jindal
Kailash
K
Pannu
Neesh
N
D000328:Adult; D000368:Aged; D001794:Blood Pressure; D001810:Blood Volume; D002940:Circadian Rhythm; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions / Q000627:therapeutic use; D045604:Extracellular Fluid / Q000378:metabolism; D005260:Female; D005936:Glucans / Q000627:therapeutic use; D005947:Glucose / Q000627:therapeutic use; D006801:Humans; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000378:metabolism* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000379:methods; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000009:adverse effects* / Q000379:methods*; D010537:Peritoneum / Q000378:metabolism; D011237:Predictive Value of Tests; D012964:Sodium / Q000378:metabolism; D014882:Water-Electrolyte Balance
D015314:Dialysis Solutions; D005936:Glucans; D000077607:Icodextrin; D012964:Sodium; D005947:Glucose