Trends in Automated Peritoneal Dialysis Prescriptions

In the largest analysis of incident automated peritoneal dialysis (APD) prescriptions in the United States to date, Harold E. Giles and other researchers examined variations in peritoneal dialysis (PD) prescriptions among patients with incident APD who remain on PD for ≥120 days. 

 The retrospective analysis included data from a large dialysis organization on patients who initiated PD with APD between 2015 and 2019. Prescription data were categorized by calendar year, timing of PD, and residual renal function. Researchers assessed changes in prescriptions from PD initiation (day 1) to day 120. 

 The cohort included 11,659 patients. Mean age at PD initiation increased from 2015 (56 [15] years) through 2019 (58 [15] years). Most other variables showed no clear temporal change. Most patients (86%) were prescribed nighttime PD, with an average of 4.9 (1.3) cycles per day, a mean total treatment volume of 9.3 (2.5) L, and a median daily total dwell time of 7 (6.0-9.5) hours. Relative to day 1 nighttime prescriptions, there were small increases in the proportion of patients receiving three or fewer cycles per day and those receiving six or more cycles per day; a 100-mL mean increase in fill volume per exchange; and a mean 0.5-L increase in total nighttime treatment volume at day 120. Changes in nighttime APD prescriptions were evaluated at the patient level; 49% of patients had day 120 prescriptions that were unchanged from their initial prescription. 

 The study authors concluded that most patients were prescribed nocturnal PD only, with limited variability across the first 4 months of therapy. 

Source: Clinical Journal of the American Society of Nephrology