Ghulam Abbas, Tahir Shafi.
One litre-one hour exchange for acute peritoneal dialysis as a cost effective approach.
J Coll Physicians Surg Pak Jan ;17(7):413-5.

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. Design: A comparative study. Place and Duration of Study: Nephrology Department, Shaikh Zayed Hospital, Lahore, from August 2006 to February 2007. Patients and 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). Conclusion: 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.

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