Comparison of Clinical Outcomes between High-Start and Low-Start Dialysate Fill Volume among Patients with CKD on Peritoneal Dialysis at the National Kidney and Transplant Institute: A Randomized Controlled Trial

Background: There is a lack of consensus among nephrologists on the optimal peritoneal dialysis(PD) choice of starting on low fill or high fill volume due to data gaps. Methods: This randomized controlled trial included 50 CKD patients at National Kidney Transplant Institute from December 2023 to March 2024. Patients were randomly allocated into two groups to receive either high-start or low-start dialysate fill volume. Endpoints of the study are adverse events and changes from baseline of PD parameters at day 14 of the treatment period. Results: A significant difference in the pre-and post-treatment in terms of improved eGFR in the low-start group (4.3±2.5 vs 6.9±4.0; D =2.63; p<0.001); increased serum albumin in the high-start group (3.2±0.5 vs 3.5±0.4; D =0.30, p=0.025); and decreased BUN in both high-start (106.2±42.8 vs 53.1±21.3; D =53.09; p<0.001) and low-start group (106.1±36.7 vs 50.8±19.6; D =53.09; p<0.001). In terms of adverse events, bleeding was significantly associated with low-start fill volume (p=0.037). However, groups did not vary significantly in terms of pericatheter leak (RR=1.67; p=0.440); abdominal pain (RR=1.27, p=0.659); swelling (RR=1, p=1); catheter migration (p=0.018); obstruction (RR=0.75, p=0.683); peritonitis (p=0.312) and other complications (RR=1.5, p=0.637). Conclusion: High-start fill volume resulted in significantly improved post-treatment serum albumin and BUN levels. It was well tolerated and associated with significantly lower bleeding rates compared to low-start fill volume.