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Xie Y, Feng X, Gao Y, Zhan X, Peng F, Zhou Q, Wu X, Wang X, Tian N, Xu Q, Su N, Tang X, Liang J, Li J, Wen Y. Association of albumin to non-high-density lipoprotein cholesterol ratio with mortality in peritoneal dialysis patients. Ren Fail 2024; 46:2299601. [PMID: 38193165 PMCID: PMC10778424 DOI: 10.1080/0886022x.2023.2299601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 12/21/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE Malnutrition and inflammation are associated with mortality in peritoneal dialysis (PD) patients. Serum albumin and non-high-density lipoprotein cholesterol (non-HDL-C) are independently associated with mortality in PD patients. Combining albumin and non-HDL-C with mortality may be more plausible in clinical practice. METHODS This retrospective cohort study included 1954 Chinese PD patients from 1 January 2009 to 31 December 2016. Kaplan-Meier curve was used to determine the relationship between albumin to non-HDL-C ratio and all-cause mortality. Cox regression analysis was applied to assess the independent predictive value while adjusting for confounding factors. Competitive risk analysis was used to examine the effects of other outcomes on all-cause mortality prognosis. RESULTS In the 33-month follow-up period, there were 538 all-cause deaths. Kaplan-Meier analysis presented significant differences in all-cause mortality. Multivariate Cox regression showed that the risk of all-cause mortality was lower in the moderate group (9.36-12.79) (HR, 0.731; 95% CI, 0.593-0.902, p = 0.004) and the highest group (>12.79) (HR, 0.705; 95% CI, 0.565-0.879, p = 0.002) compared to the lowest group (≤9.36). Competitive risk analysis revealed significant differences for all-cause mortality (p < 0.001), while there was no statistical significance for other competing events. CONCLUSIONS Low albumin to non-HDL-C ratio was associated with a high risk of all-cause mortality in PD patients. It may serve as a potential prognostic biomarker in PD patients.
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Affiliation(s)
- Yongjie Xie
- Department of Nephrology, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, PR China
| | - Xiaoran Feng
- Department of Nephrology, Jiujiang NO.1 People’s Hospital, Jiangxi, PR China
| | - Youqun Gao
- Department of Nephrology, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, PR China
| | - Xiaojiang Zhan
- Department of Nephrology, The First Affiliated Hospital of Nanchang University, Nanchang, PR China
| | - Fenfen Peng
- Department of Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou, PR China
| | - Qian Zhou
- Department of Medical Statistics, Clinical Trials Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, PR China
| | - Xianfeng Wu
- Department of Nephrology, Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, PR China
- Clinical Research Center for Chronic Kidney Disease, Affiliated Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, PR China
| | - Xiaoyang Wang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, PR China
| | - Na Tian
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, PR China
| | - Qingdong Xu
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen, PR China
| | - Ning Su
- Department of Hematology, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Xingming Tang
- Department of Nephropathy and Rheumatism, Dongguan Songshan Lake Tungwah Hospital, Dongguan, PR China
| | - Jianbo Liang
- Department of Nephrology, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, PR China
| | - Jiao Li
- Department of Nephrology, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, PR China
- Department of Cardiovascular, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, PR China
| | - Yueqiang Wen
- Department of Nephrology, the Second Affiliated Hospital, Guangzhou Medical University, Guangzhou, PR China
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Kiebalo T, Holotka J, Habura I, Pawlaczyk K. Nutritional Status in Peritoneal Dialysis: Nutritional Guidelines, Adequacy and the Management of Malnutrition. Nutrients 2020; 12:E1715. [PMID: 32521626 PMCID: PMC7352713 DOI: 10.3390/nu12061715] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/30/2020] [Accepted: 06/04/2020] [Indexed: 12/11/2022] Open
Abstract
The positive impact of nutritional status on the health and treatment adequacy of peritoneal dialyzed patients has been well established. Protein intake is an important factor used to stratify malnutrition, with inadequate intake leading to protein-energy wasting during the course of therapy. In this review, we discuss the recommendations made by nephrological societies regarding nutrition in this population of dialysis patients. Special attention is given to the intake of protein, and recommendations on the intake of micronutrients are also discussed. Furthermore, factors that may impair nutritional intake and balance are discussed, with mention of the innovative strategies utilized to combat them. In light of inconsistent recommendations that vary between each respective society, as well as a general lack of concise information, it is our intention to call for further research regarding nutritional recommendations in peritoneal dialysis (PD), as well as to advocate for clear and accessible information for patients.
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Affiliation(s)
- Thomas Kiebalo
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (T.K.); (J.H.)
| | - Jacqueline Holotka
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (T.K.); (J.H.)
| | - Ireneusz Habura
- Department of Nephrology, University Hospital of Karol Marcinkowski in Zielona Gora, 65-046 Zielona Gora, Poland;
| | - Krzysztof Pawlaczyk
- Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, 60-355 Poznan, Poland; (T.K.); (J.H.)
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3
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Chung SH, Na MH, Lee SH, Park SJ, Chu WS, Lee HB. Nutritional Status of Korean Peritoneal Dialysis Patients. Perit Dial Int 2020. [DOI: 10.1177/089686089901902s88] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objectives To assess the nutritional status of Korean peritoneal dialysis (PD) patients and to compare with data from Western literature, and to elucidate independent factors determining nutritional status and death. Design Cross-sectional single-center study. Setting Kidney Center, Soon Chun Hyang University Hospital. Materials Ninety-eight CAPD patients were included. Of these, 54 patients were male, 32 patients were diabetic, mean age was 47.9 :i: 13.1 years, and mean duration of CAPD was 22.3 :i: 21.6 months. The patients were followed until death, transfer to hemodialysis (HD) or other units, transplantation, or until 3 years had elapsed after the first evaluation. Methods Nutritional status was assessed by subjective global assessment (SGA), biochemical and anthropometric measurements, fat-free edema-free (FFEF) body mass by creatinine (Cr) kinetics, protein equivalent of total nitrogen appearance (PNA), and urea kinetic studies. Results By SGA score, 53.1% of patients were classified as normal, 44.9% with mild-to-moderate malnutrition, and 2% with severe malnutrition. Patients with malnutrition were significantly older and had higher peritonitis rates, lower serum albumin (Alb), blood urea nitrogen (BUN), serum Cr, FFEF body mass, mid arm muscle circumference, and PNA (p < 0.05). On stepwise multiple regression analysis, the SGA score was negatively correlated with age and peritonitis rate (p < 0.01). At the end of the 3-year follow-up period, 11 patients were still on CAPD, 26 had died, 51 had transferred to HD and 5 to other units, 3 patients had been transplanted, and 2 patients were lost to follow-up. Patients who died during follow-up were older and had higher peritonitis rates and lower total serum protein, Alb, Cr, and FFEF body mass when compared to those who survived (p < 0.05). Independent predictors of death were age, peritonitis rate, and serum Alb (p < 0.01). Conclusion Malnutrition was as common in Korean PD patients as reported in the Western literature. Our data suggests that, to prevent malnutrition and early death, it is important to reduce the peritonitis rate, to improve protein intake, and to prescribe an adequate dose of peritoneal dialysis.
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Affiliation(s)
- Sung Hee Chung
- Kidney Center; Soon Chun Hyang University Hospital, and Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Myung Hee Na
- Kidney Center; Soon Chun Hyang University Hospital, and Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Sui Hyung Lee
- Kidney Center; Soon Chun Hyang University Hospital, and Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Sung Ja Park
- Kidney Center; Soon Chun Hyang University Hospital, and Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Won Seck Chu
- Kidney Center; Soon Chun Hyang University Hospital, and Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
| | - Hi Bahl Lee
- Kidney Center; Soon Chun Hyang University Hospital, and Hyonam Kidney Laboratory, Soon Chun Hyang University, Seoul, Korea
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4
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Burkart JM. Ysis Prescription and Peritoneal Membrane Transport Characteristics on Nutritional Status. Perit Dial Int 2020. [DOI: 10.1177/089686089501505s03] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
These data suggest that dialysis dose is one of the major determinants of protein and energy intake in PD patients and that higher doses of dialysis tend to improve outcome. The data also suggest that with a long time on PD the peritoneal membrane probably has some underlying histological changes that preclude it from optimally responding to injury and may predispose it to irreversible damage. A possible early finding in this case is an increase in peritoneal transport in patients whose transport was initially stable. Peritoneal membrane transport properties are an important determinant of not only dialysis dose, but also nutritional status via both direct and indirect means. It is therefore important to identify the individual patient's peritoneal membrane transport characteristics. These transport characteristics may change over time. High transporters on CAPD represent a unique challenge. They have ultrafiltration problems and a tendency toward protein malnutrition presumably due to increased dialysate protein losses while on CAPD. One must consider that malnutrition in a rapid transporter may be due to the fact that the patient is on the wrong PD therapy. A change to NIPD may rectify some of the biochemical parameters, but these patients may not always improve. Reasons for this occasional lack of improvement are multifactorial, but emphasize our need to look at each patient as an individual and not focus only on laboratory parameters.
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Affiliation(s)
- John M. Burkart
- Bowman Gray School of Medicine, Winston-Salem, North Carolina, U.S.A
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5
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Wang T, Waniewski J, Heimbürger O, Bergstrβm J, Werynski A, Lindholm B. A Simple and Fast Method to Estimate Peritoneal Membrane Transport Characteristics Using Dialysate Sodium Concentration. Perit Dial Int 2020. [DOI: 10.1177/089686089901902s35] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BackgroundThe peritoneal equilibration test (PET) is widely used to classify a patient's peritoneal transport characteristics. However, PET is laborious and the prediction of fluid removal based on PET is generally poor. It is believed that osmosis by glucose occurs partially through transcellular water channels, resulting in sieving of sodium and decrease of dialysate sodium concentration when using hypertonic glucose dialysate.ObjectiveIn this study, we investigated the possibility of using dialysate sodium concentration to classify the patient's peritoneal transport characteristics.MethodsA 6-hour dwell study with frequent dialysate and plasma sampling was performed in 46 patients using 2 L of 3.86% glucose dialysate with 1311-albumin as an intraperitoneal volume (IPV) marker. The peritoneal transport of sodium, creatinine, glucose, and fluid was evaluated.ResultsThe dialysate sodium concentration at 240 min (ONa240) significantly correlated with O/P creatinine (r = 0.76, p < 0.001) and O/O0 glucose (r = -0.83, p < 0.001) at 240 min of the dwell (better than dialysate sodium concentration at any other time of the dwell). ONa240 also significantly correlated with IPV at 240 min of the dwell (r = -0.61, p < 0.001) (better than O/P creatinine and O/O0 glucose). There were significant correlations between ONa240 and the sodium-sieving coefficient (r= 0.71, p < 0.001) and the diffusive mass transfer coefficient for sodium (r = 0.50, p < 0.001). When using ONa240 to divide the patients into four groups, as in the PET method, no significant difference was found between the two methods.ConclusionUsing 3.86% glucose solution, ONa240 can be used instead of O/P creatinine to classify patients into different transport groups. ONa240 provides a better prediction of peritoneal fluid transport and reflects both the diffusive and convective transport properties of the membrane. As only one dialysate sample (and no blood sample) is needed, ONa240 may offer important clinical advantages compared with PET.
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Affiliation(s)
- Tao Wang
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Sciences, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| | - Jacek Waniewski
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Sciences, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
- Divisions of Baxter Novum and Renal Medicine, Institute of Biocybernetics and Biomedical Engineering, 2 Warsaw, Poland
| | - Olof Heimbürger
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Sciences, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| | - Jonas Bergstrβm
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Sciences, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
| | - Andrzej Werynski
- Divisions of Baxter Novum and Renal Medicine, Institute of Biocybernetics and Biomedical Engineering, 2 Warsaw, Poland
| | - Bengt Lindholm
- Divisions of Baxter Novum and Renal Medicine, Department of Clinical Sciences, Karolinska Institute, Huddinge University Hospital, Stockholm, Sweden
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6
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Dimaano JUF, London RD, Dowling J, Marcus RG. Increase in Kt/V Increased Serum Albumin but Not Npcr in a Group of Patients on Continuous Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089701700516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | - Roger D. London
- Departments of Medicine, Dietary Services, and Nursing Mount Sinai Medical Center New York, New York, U.S.A
| | - Joanna Dowling
- Departments of Medicine, Dietary Services, and Nursing Mount Sinai Medical Center New York, New York, U.S.A
| | - Roy G. Marcus
- Departments of Medicine, Dietary Services, and Nursing Mount Sinai Medical Center New York, New York, U.S.A
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7
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Abstract
High transporters on chronic peritoneal dialysis are challenged by increased protein losses, high glucose absorption with associated metabolic abnormalities, and poor ultrafiltration. Furthermore, the relative risk of mortality and technique failure is higher in high transporters than in patients of other transport types. An approach for satisfactory management of such patients on peritoneal dialysis (PD) has not been clearly demonstrated.
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Affiliation(s)
- Alok Agrawal
- Division of Nephrology, Department of Internal Medicine, University of Missouri Health Sciences Center, Dalton Cardiovascular Research Center and Dialysis Clinics, Inc., Columbia, Missouri, U.S.A
| | - Karl D. Nolph
- Division of Nephrology, Department of Internal Medicine, University of Missouri Health Sciences Center, Dalton Cardiovascular Research Center and Dialysis Clinics, Inc., Columbia, Missouri, U.S.A
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8
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Heaf JG, Honoré K, Valeur D, Randlov A. The Effect of Oral Protein Supplements on the Nutritional Status of Malnourished Capd Patients. Perit Dial Int 2020. [DOI: 10.1177/089686089901900115] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- James G. Heaf
- Department of Nephrology B Copenhagen University Hospital in Herlev Herlev, Denmark
| | - Ketty Honoré
- Department of Nephrology B Copenhagen University Hospital in Herlev Herlev, Denmark
| | - Dorthe Valeur
- Department of Nephrology B Copenhagen University Hospital in Herlev Herlev, Denmark
| | - Annette Randlov
- Department of Nephrology B Copenhagen University Hospital in Herlev Herlev, Denmark
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9
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Kathuria P, Moore HL, Khanna R, Twardowski ZJ, Goel S, Nolph KD. Effect of Dialysis Modality and Membrane Transport Characteristics on Dialysate Protein Losses of Patients on Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089701700507] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To determine if peritoneal dialysis modality has an impact on protein losses in dialysate. Design Retrospective, cross-sectional study. Patients 190 patients who had selected peritoneal dialysis were classified into one of four transport categories (high, high-average, low-average, or low) based on standard peritoneal equilibration test results. Patients were then assigned to continuous ambulatory peritoneal dialysis (CAPD) or nightly intermittent peritoneal dialysis (NIPD) based on membrane transport characteristics and individual preferences. Results Patients with similar membrane transport characteristics had essentially no differences in dialysate protein and albumin losses whether treated with CAPD or NIPD. Conclusions Although high transporters may be better managed with short -dwell therapies such as nocturnal intermittent peritoneal dialysis or daily ambulatory peritoneal dialysis, consistent marked decreases in protein losses cannot be cited as a benefit of NIPD over CAPD.
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Affiliation(s)
- Pranay Kathuria
- Department of Internal Medicine, Division of Nephrology, University of Missouri-Columbia, and Dalton Cardiovascular Research Center, Columbia, Missouri, U.S.A
| | - Harold L. Moore
- Department of Internal Medicine, Division of Nephrology, University of Missouri-Columbia, and Dalton Cardiovascular Research Center, Columbia, Missouri, U.S.A
| | - Ramesh Khanna
- Department of Internal Medicine, Division of Nephrology, University of Missouri-Columbia, and Dalton Cardiovascular Research Center, Columbia, Missouri, U.S.A
| | - Zbylut J. Twardowski
- Department of Internal Medicine, Division of Nephrology, University of Missouri-Columbia, and Dalton Cardiovascular Research Center, Columbia, Missouri, U.S.A
| | - Sharad Goel
- Department of Internal Medicine, Division of Nephrology, University of Missouri-Columbia, and Dalton Cardiovascular Research Center, Columbia, Missouri, U.S.A
| | - Karl D. Nolph
- Department of Internal Medicine, Division of Nephrology, University of Missouri-Columbia, and Dalton Cardiovascular Research Center, Columbia, Missouri, U.S.A
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10
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Tzamaloukas A, Braun M, Malhotra D, Murata G. Estimated versus Predicted Creatinine Generation as an Indicator of Compliance with the Prescribed Dose of Continuous Peritoneal Dialysis. Int J Artif Organs 2018. [DOI: 10.1177/039139889601900303] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The expression (Estimated - Predicted)/Predicted creatinine generation {(E-P)IP} has been proposed as an index of compliance in continuous peritoneal dialysis (CPD). We attempted to define an (E-P)IP value that can be used as a cut-off for non-compliance and to characterize the relation of (E-P)IP to serum albumin. In 324 clearance studies, (E-P)/P had a normal distribution with a mean of +0.094 and an SD of 0.357. In these studies, there was a weak correlation between (E-P)/P and serum albumin (r=0.12, P<0.05), but (E-P)/P was not a predictor of serum albumin by logistic regression. In 34 CPD patients, who had an increase in the dose of CPD resulting in an increase in measured creatinine clearance from 43.8 ± 14.0 to 66.1 ± 17.6 L/1.73 m2 weekly (P<0.001), (E-P)/P increased correspondingly from +0.018 ± 0.284 to +0.153 ± 0.369 (P = 0.018), although all subjects should be in a steady state of creatinine excretion in the second study. The rise in (E-P)/P was statistically significant in the subgroup of 17 subjects who had a decrease in serum albumin, but not in the subgroup of 14 subjects who had an increase in serum albumin from the first to the second clearance study. The (E-P)/P cut-off for a definitive diagnosis of CPD non-compliance may be around +0.400 or +0.500. The findings of this study suggest that non-compliance, as indicated by (E-P)/P, has an adverse effect on serum albumin and that non-compliance increases after a prescribed increase in the dose of CPD.
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Affiliation(s)
- A.H. Tzamaloukas
- Renal Section and Primary Care Section, Albuquerque Veterans Affairs Medical Center and Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico - USA
| | - M. Braun
- Renal Section and Primary Care Section, Albuquerque Veterans Affairs Medical Center and Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico - USA
| | - D. Malhotra
- Renal Section and Primary Care Section, Albuquerque Veterans Affairs Medical Center and Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico - USA
| | - G.H. Murata
- Renal Section and Primary Care Section, Albuquerque Veterans Affairs Medical Center and Division of Nephrology, University of New Mexico School of Medicine, Albuquerque, New Mexico - USA
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12
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Pérez-Fontán M, Rodríguez-Carmona A. Comparing Capd and Automated Peritoneal Dialysis: Where do Solute Transport Issues Stand? Perit Dial Int 2007. [DOI: 10.1177/089686080702700212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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13
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Rumpsfeld M, McDonald SP, Johnson DW. Higher peritoneal transport status is associated with higher mortality and technique failure in the Australian and New Zealand peritoneal dialysis patient populations. J Am Soc Nephrol 2005; 17:271-8. [PMID: 16306167 DOI: 10.1681/asn.2005050566] [Citation(s) in RCA: 122] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Although early studies observed that peritoneal membrane transport characteristics were determinants of morbidity and mortality in peritoneal dialysis (PD) patients, more recent investigations, such as the Ademex trial, have refuted these findings. The aim of this study was to determine whether baseline peritoneal transport status predicted subsequent survival in Australian and New Zealand PD patients. The study included all adult patients in Australia and New Zealand who commenced PD between April 1, 1999, and March 31, 2004, and had a peritoneal equilibration test (PET) performed within 6 mo of PD commencement. Times to death and death-censored technique failure were examined by Kaplan-Meier analyses and multivariate Cox proportional hazards models. PET measurements were available in 3702 (72%) of the 5170 individuals who began PD treatment in Australia or New Zealand during the study period. In these patients, high transporter status was found to be a significant, independent predictor of death-censored technique failure (adjusted hazard ratio [AHR] 1.23; 95% confidence interval [CI] 1.02 to 1.49; P = 0.03) and mortality (AHR 1.34; 95% CI 1.05 to 1.79, P = 0.02) compared with low-average transport status. High-average transport class was also associated with mortality (AHR 1.21; 95% CI 1.00 to 1.48; P = 0.047) but not death-censored technique failure (AHR 1.04; 95% CI 0.90 to 1.21) compared with low-average transport status. When transport status was alternatively analyzed as a continuous variable, dialysate:plasma creatinine ratio at 4 h was independently predictive of both death-censored technique failure (AHR 1.07; 95% CI 1.01 to 1.295; P = 0.031) and death (AHR 1.09; 95% CI 1.01 to 1.373; P = 0.036 per 0.1 change in dialysate:plasma creatinine). Peritoneal transport rate is a highly significant risk factor for both mortality and death-censored technique failure in the Australian and New Zealand incident PD patient populations.
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Affiliation(s)
- Markus Rumpsfeld
- Department of Renal Medicine, Level 2, Ambulatory Renal and Transplant Services Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane Qld 4102, Australia
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14
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Abstract
The National Kidney Foundation-Dialysis Outcomes Quality Initiatives guidelines have standardized many aspects of treating end-stage renal disease patients with peritoneal dialysis in an attempt to improve overall patient outcome. While recommending certain total solute clearance goals, the guidelines have also pointed out deficiencies in our knowledge base and precipitated many controversies. Some of these controversies have been resolved while others may have been interpreted wrongly, unnecessarily resulting in transfer of patients from peritoneal dialysis to hemodialysis due to "failure to meet adequacy targets" even when doing well clinically. This report reviews the rationale for the original guidelines and their subsequent modification. It also outlines a rational approach toward prescription modification based on peritoneal physiology. Specific solute clearance target goals discussed are the modifications for continuous ambulatory peritoneal dialysis (CAPD) and cycler peritoneal dialysis (CCPD), and a review of what solute clearance targets subsequent guidelines from other countries have used. Some examples are as follows: new guidelines suggest that solute clearance goals for creatine clearance should differ for low and low-average transporters than for high and high-average transporters (weekly clearance of 50 and 60 1/1.73 m(2), respectively) while Kt/V targets remain unchanged. Also discussed is the rationale for having the same target for patients on CCPD with a mid-day exchange as those for patients on CAPD. We are also reminded that solute clearance is only one aspect of "adequate" dialysis-blood pressure and volume control are equally important, and ways to maintain euvolemia and blood pressure control are discussed in the context of prescription management.
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Affiliation(s)
- J M Burkart
- Department of Internal Medicine/Nephrology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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15
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Abstract
Recent studies have shown that patients with high peritoneal transport characteristics have substantially increased morbidity and mortality. This finding is counter-intuitive, since HTs will a priori achieve higher clearances. There are many possible causes: increased protein losses with consequent hypoalbuminemia; poor ultrafiltration capacity causing fluid retention, ventricular hypertrophy and hypertension; increased glucose absorption leading to anorexia, hyperinsulinism, and local AGE formation; and the development of an atherogenic lipid profile. While common pathogenic causes of high peritoneal transport and atherosclerosis have been hypothesized, it is more likely that CAPD as currently practiced is unsuitable for HTs, who should be switched to HD or NIPD. Renal and peritoneal clearances have different clinical effects and should be assessed separately. Current measures of dialysis adequacy, such as total Kt/V, do not therefore describe the patient's clinical situation accurately and are insufficient.
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Affiliation(s)
- J Heaf
- Department of Nephrology B, Copenhagen University Hospital, Herlev, Denmark.
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16
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Tzamaloukas AH. Peritonitis in peritoneal dialysis patients: an overview. ADVANCES IN RENAL REPLACEMENT THERAPY 1996; 3:232-6. [PMID: 8827203 DOI: 10.1016/s1073-4449(96)80027-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The incidence of peritonitis in peritoneal dialysis (PD) patients has decreased as a result of improvements in PD technology. Nevertheless, peritonitis remains a major problem in PD, with a substantial percent of patients developing persistent or relapsing infections. Current treatment guidelines emphasize the use of intraperitoneal antibiotics and once-a-day administration of aminoglycosides and provide indications for removal of the peritoneal catheter. Further clinical studies testing these guidelines are needed. In addition, guidelines for patients on PD treatment modalities other than standard continuous ambulatory peritoneal dialysis (CAPD) need to be developed. Peritonitis may lead to extensive adhesion formation, peritoneal fibrosis of varying severity, permanent loss of peritoneal ultrafiltration, severe malnutrition, sepsis, and death. Special forms of peritonitis requiring great care and further study include those caused by fungi, mycobacteria, and multiple microorganisms, and those developing in HIV-positive PD patients.
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Affiliation(s)
- A H Tzamaloukas
- University of New Mexico School of Medicine, Albuquerque, USA
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