Lower-Dosage Acute Peritoneal Dialysis versus Acute Intermittent Hemodialysis in Acute Kidney Injury: A Randomized Controlled Trial.

Key Points: The efficacy of acute peritoneal dialysis is still controversial. There was no significant difference in 28-day mortality between acute peritoneal dialysis and intermittent hemodialysis.

Background: Lower delivered dose of acute peritoneal dialysis (PD) in AKI requires less resources but raises concerns regarding adequate solute and water clearance. The relative merits of lower-dose PD versus intermittent hemodialysis remain uncertain.

Methods: A multicenter randomized controlled trial compared the outcomes between acute lower-dosage PD (18–24 L per day) and intermittent hemodialysis (three times per week) from May 2018 to January 2021 in patients with AKI. The primary outcome was 28-day mortality rate. Secondary outcomes included 28-day dialysis-free survival and kidney recovery, metabolic profile, and procedure-related complications. Noninferiority of PD to hemodialysis would be demonstrated if the upper bound of the 95% confidence interval ( CI) on risk difference (PD-hemodialysis) in 28-day mortality rates between the two groups was <20%.

Results: We included 157 patients (80 allocated to PD and 77 to intermittent hemodialysis). Before KRT initiation, baseline clinical characteristics between groups were comparable. The overall mean age was 57±15 years. The most frequent cause of AKI was sepsis (68%). There was no difference in 28-day mortality between acute PD and intermittent hemodialysis (50% versus 49%, risk difference 0.6 [95% CI, −15.0 to 16.3]), and 28-day dialysis-free survival (42% versus 37%, risk difference 4.6 [95% CI, −11.1 to 20.3]). Mean weekly Kt/V urea was 2.11±1.14 and 2.55±1.11 in the PD and intermittent hemodialysis groups, respectively. The 7-day fluid balance of PD and intermittent hemodialysis patients was not significantly different. There was more frequent intradialytic hypotension in the intermittent hemodialysis group and more frequent hypokalemia in the PD group.

Conclusions: In this study of patients with AKI, there was no significant difference in 28-day mortality between acute PD and intermittent hemodialysis.