Discussion
PD, ’ mistakes, MPD
COMPLICATION, COMPLICATIONS, LEAKAGE
This study is the first to combine APD with MPD in the treatment of USPD. Compared with MPD, the A-MPD mode had a better effect on removing small-molecule toxins. Simultaneously, the A-MPD mode could effectively save time for nurses treating PD and improve the skill training of patients. The incidence of short-term complications, PD technique survival, and mortality were not significantly different between the two modes. Therefore, the A-MPD mode may be recommended as an adaptable and suitable PD mode for USPD treatment.Recent studies have shown that the APD mode has a better effect on removing small-molecule toxins than MPD in USPD [The design of the A-MPD model should consider the adequacy of dialysis, the practicability, the time expenditure of nurses treating PD, and the tolerance of patients. For the MPD mode, previous studies have adopted four to six exchanges per day [An interesting finding of our study is that patients in the A-MPD group received higher test scores with shorter time expenditures for nurses treating PD. Once the cycler was connected to the PDC, the nurses treating PD did not need to wait by the patient’s bed or weigh the dialysate, which obviously reduces time expenditure. This probably gave the nurses treating PD more time and patience to conduct patient training and promptly correct patients’ mistakes during dialysate exchange. Meanwhile, if the patients only had APD, they learned MPD using only the artificial model. The patients then had no opportunity to do MPD on themselves and had no real practical experience. This finding further demonstrates that A-MPD could reduce the burden of the nurse and improve the skill of patients, which is more suitable than APD or MPD alone.Previous studies have found that the APD mode could increase the loss of serum albumin more than MPD in patients during USPD [Dialysate leakage is a common complication after PDC implantation, and its incidence in USPD reported in the literature ranges from 2.2% to 37% [No significant difference in the PD technique survival or mortality was found between the two groups during the six-month follow-up period. Therefore, we consider that the five-day USPD treatment would not affect the PD technical survival rate and mortality during follow-up because of our study’s limited sample size and many other factors that affect PD after discharge.In this study, the PD catheters were implanted by open surgical dissection or laparoscopy. Recently, percutaneous catheterization was more and more widely used in USPD. A real-world, multicenter, retrospective cohort study found percutaneous catheterization was more commonly used for a break interval <24 h and laparoscopic or open surgery method was more commonly used for a break interval >7 days [Our study had some limitations. First, it was a single-center study with a limited number of patients. Therefore, more multicenter studies with larger sample sizes are required. Second, the optimal prescriptions for USPD still need to be determined. Here, we considered the dialysis dose, dwell time, exchange cycles, the patient’s tolerance, safety, the patient’s training, and time expenditure. Future studies should consider the symptoms, urine volume, and ultrafiltration, among others, and individualize the prescription according to each patient.