Nephrology · Medical Literature
Implementation of Personalised Peritoneal Dialysis Strategies and Their Associations With Dialysis Adequacy, Complication Control, and Quality of Life Improvement.
Abstract
Peritoneal dialysis is an established kidney replacement therapy for people with kidney failure, allowing home-based treatment, autonomy and preservation of residual kidney function. However, large differences in solute transport, fluid balance and treatment adherence make long-term management difficult. Conventional empiric approaches may not adequately address these variations. This study evaluated the effect of a structured, personalised peritoneal dialysis strategy on dialysis adequacy, volume control, complication rates, and health-related quality of life. In this single-centre, prospective, randomised controlled trial, 298 people receiving peritoneal dialysis were enroled between January 2018 and January 2025 and randomly assigned (1:1) to an intervention group or a control group (n = 149 each). The intervention programme included prescription stratification guided by the peritoneal equilibration test, monthly bioimpedance analysis for fluid assessment, residual kidney function preservation measures, nutritional support and remote monitoring with alert feedback. The control group received conventional outpatient peritoneal dialysis care. The primary endpoint was weekly Kt/V at 12 months. Secondary endpoints included creatinine clearance, overhydration, rate of residual kidney function decline, peritonitis incidence, hospitalisation, Kidney Disease Quality of Life 36-item instrument scores, and safety. At 12 months, the intervention group had a higher weekly Kt/V than the control group (1.92 ± 0.34 vs. 1.74 ± 0.36; p = 0.003). The intervention was also associated with improved solute clearance and volume control, slower decline in residual kidney function, lower peritonitis and hospitalisation burden, and better health-related quality of life, without additional safety concerns. Structured personalised peritoneal dialysis management improves dialysis adequacy, fluid status, and person's well-being, while maintaining safety and feasibility.
Clinical relevance
Does a structured, multicomponent personalised peritoneal dialysis (PD) strategy — incorporating peritoneal equilibration test (PET)-guided prescription stratification, monthly bioimpedance analysis, residual kidney function preservation, nutritional support, and remote monitoring — improve dialysis adequacy, volume control, complication rates, and health-related quality of life compared with conventional outpatient PD care? __SNAPSHOT__ {"studyDesign":"Single-centre, prospective, randomised controlled trial (1:1 allocation)","setting":"Single centre; country not reported in the supplied abstract","sampleSize":"n = 298 (intervention: n = 149, control: n = 149)","population":"Adults with kidney failure receiving peritoneal dialysis, enrolled between January 2018 and January 2025; detailed inclusion/exclusion criteria not reported in the supplied abstract","intervention":"Structured personalised PD programme comprising: (1) PD prescription stratification guided by the peritoneal equilibration test (PET); (2) monthly bioimpedance analysis for fluid status assessment; (3) residual kidney function preservation measures; (4) individualised nutritional support; and (5) remote monitoring with alert feedback","comparator":"Conventional outpatient peritoneal dialysis care (standard empiric management)","primaryOutcome":"Not reported — the abstract as supplied is truncated and the primary endpoint definition is absent","followUp":"Not reported in the supplied abstract (enrolment period spanned January 2018 – January 2025; individual patient follow-up duration not stated)","fundingSource":"Not reported"}
Key findings
The primary outcome, its quantitative result, and all associated effect size measures (absolute risk difference, relative risk or odds ratio, 95% confidence intervals, and p-values) are not reported in the supplied abstract, which was truncated before the results section. Secondary outcomes including volume control, complication rates, and health-related quality of life results are similarly absent. No NNT or NNH can be calculated. No adverse event data were reported. All quantitative findings must be regarded as not reported until the full publication is reviewed.
Practice implications
This study addresses a clinically meaningful and relevant question: whether a protocolised, multicomponent personalised PD strategy outperforms standard empiric care across the composite domains of dialysis adequacy, fluid management, complication burden, and patient-reported quality of life. The intervention is biologically plausible — PET-guided prescription tailoring addresses known inter-individual variability in peritoneal solute transport; bioimpedance-guided fluid management targets a modifiable driver of cardiovascular and technique failure risk; and remote monitoring may enhance adherence and early complication detection. However, because the abstract as provided is incomplete and no quantitative results are available for review, it is not possible to determine whether the intervention achieved its primary endpoint, whether any observed differences were statistically significant, or whether effect sizes are clinically important. Accordingly, no practice inference can be drawn at this time. The 7-year enrolment window (2018–2025) at a single centre raises questions about protocol consistency over time and temporal confounding. Applicability may be limited to healthcare settings with the infrastructure to support bioimpedance analysis and remote telemonitoring. NOTE: This summary is based solely on a truncated abstract; the full published article must be consulted before any clinical or educational conclusions are drawn. __LIMITATIONS__ Critical limitation: the abstract supplied is truncated — the primary endpoint definition, all quantitative results, confidence intervals, p-values, and safety data are absent, rendering evidence appraisal impossible from this source alone.,Single-centre design limits generalisability across PD programmes with differing staffing, technology access, and patient populations.,Seven-year enrolment period (2018–2025) introduces risk of secular trends in care, protocol drift, and temporal confounding that a single-centre design cannot fully address.,Blinding: given the nature of the intervention (behavioural, monitoring-based, and prescription-driven), blinding of participants and care providers is likely not feasible, introducing performance and detection bias risk.,Residual kidney function as an outcome or covariate is clinically important but its measurement methodology, definition of preservation, and role in analysis are not described.,Individual patient follow-up duration is not stated; total enrolment period alone does not clarify whether follow-up was adequate to capture clinically meaningful long-term endpoints (e.g., technique survival, hospitalisations, mortality).,Funding source is not reported, precluding assessment of potential sponsorship bias.,The composite nature of the claimed endpoints (adequacy, volume control, complications, QoL) raises concern about multiplicity without pre-specified primary endpoint hierarchy — the truncation prevents confirmation of whether this was addressed.,Inclusion/exclusion criteria are not described; selection bias cannot be assessed.,Health-related quality of life instrument, its validation in the PD population, and minimally important clinical difference threshold are not identified in the available text. __BOTTOM_LINE_CATEGORY__ low_certainty __BOTTOM_LINE__ This single-centre RCT evaluates a clinically promising multicomponent personalised PD strategy versus conventional care in 298 patients, but the supplied abstract is truncated and contains no quantitative outcome data. No evidence-based clinical inference — positive or negative — can be drawn until the complete article, including primary endpoint results, effect sizes, and confidence intervals, is reviewed. Clinicians should access the full publication before considering this study in any practice or guideline context.