An AQP1 variant is associated with peritoneal dialysis outcomes

Background Primary analysis of the European Automated Peritoneal Dialysis Outcomes Study (EAPOS) found that patients with daily ultrafiltration (UF) below a predefined target of 750 mL at baseline experienced increased mortality and continuing low UF over 2 years. Setting Multicenter, prospective observational study of prevalent, functionally anuric patients on automated peritoneal dialysis (APD) treated to predefined standards. Methods Secondary data analysis to determine clinical covariates that might support a link between poor UF and outcome, including pattern of comorbidity, prescription, nutrition as determined by Subjective Global Assessment (SGA), membrane function, and blood pressure (BP). Ultrafiltration was treated as a categorical (comparing patients above and below target at baseline) and continuous dependent variable in univariate and multivariate regression. The relationship between BP and survival was also explored. Results Of 177 patients recruited from 28 centers across Europe, 43 were below the UF target at baseline. Compared to those above target, there were no differences in the spread of comorbidity, type of APD prescription, SGA, BP, hemoglobin, HCO3, or parathyroid hormone, at baseline or at any later time. At baseline, plasma calcium and, at 12 months, plasma phosphate were lower in the low UF group. There was a weak positive correlation between baseline systolic or diastolic BP and UF, which remained on multivariate analysis but accounted for just 9% of the variability in BP. There was no clear relationship between baseline BP and survival, although, if anything, low BP was associated with earlier death. Poor UF was associated with lower mean dialysate glucose concentration during the first 4 months and with consistently worse membrane function. Conclusions The increased mortality associated with poor UF is likely multifactorial and not easily explained by clear differences in comorbidity, nutritional state, or other indices of treatment at baseline. The lower plasma phosphate suggests a subsequent fall in appetite. Poor BP control is unlikely to be the explanation, and a link between lower BP, reduced UF, and earlier death is suggested. Failure to achieve adequate UF due to worse membrane function remains an important and potentially reversible or preventable cause.

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National Comparisons: Optimal Peritoneal Dialysis Outcomes among Japanese Patients

Peritoneal Dialysis International ◽

10.1177/089686089901903s03 ◽

1999 ◽

Vol 19 (3_suppl) ◽

pp. 9-16 ◽

Cited By ~ 17

Author(s):

Yoshindo Kawaguchi

Keyword(s):

Peritoneal Dialysis ◽

Positive Selection ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Therapeutic Intervention ◽

Scoring System ◽

Japanese Patients ◽

Current Status ◽

Technique Survival ◽

Ultrafiltration Failure ◽

Dialysis Outcomes

This paper describes the current status of chronic dialysis in Japan and the guidelines used to initiate dialysis (scoring system), and reports the outcome of continuous ambulatory peritoneal dialysis (CAPD), focusing upon our center's experience. Fifty percent of CAPD technique survival was 6.9 ± 1.3 years among those patients classified as “positive selection.” The major causes of withdrawal from CAPD were ultrafiltration failure, the patients’ inability to continue on CAPD by themselves, and peritonitis. The clinical issues that most concern nephrologists in CAPD management are prevention and management of ultrafiltration failure, prevention/therapeutic intervention in encapsulating peritoneal sclerosis, catheter-related infections, and prevention of underdialysis.

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A Systematic Review and Jurisdictional Scan of the Evidence Characterizing and Evaluating Assisted Peritoneal Dialysis Models

Clinical Journal of the American Society of Nephrology ◽

10.2215/cjn.11951019 ◽

2020 ◽

Vol 15 (4) ◽

pp. 511-520 ◽

Cited By ~ 3

Author(s):

Mark Hofmeister ◽

Scott Klarenbach ◽

Lesley Soril ◽

Nairne Scott-Douglas ◽

Fiona Clement

Keyword(s):

Systematic Review ◽

Health Care ◽

Peritoneal Dialysis ◽

Cochrane Central Register ◽

Home Based ◽

Cochrane Database ◽

Central Register ◽

Professional Assistance ◽

Dialysis Outcomes ◽

Assisted Peritoneal Dialysis

Background and objectivesCompared with hemodialysis, home peritoneal dialysis alleviates the burden of travel, facilitates independence, and is less costly. Physical, cognitive, or psychosocial factors may preclude peritoneal dialysis in otherwise eligible patients. Assisted peritoneal dialysis, where trained personnel assist with home peritoneal dialysis, may be an option, but the optimal model is unknown. The objective of this work is to characterize existing assisted peritoneal dialysis models and synthesize clinical outcomes.Design, setting, participants, & measurementsA systematic review of MEDLINE, Cochrane Central Register of Controlled Trails, Cochrane Database of Systematic Reviews, Embase, PsycINFO, and CINAHL was conducted (search dates: January 1995–September 2018). A focused gray literature search was also completed, limited to developed nations. Included studies focused on home-based assisted peritoneal dialysis; studies with the assist provided exclusively by unpaid family caregivers were excluded. All outcomes were narratively synthesized; quantitative outcomes were graphically depicted.ResultsWe included 34 studies, totaling 46,597 patients, with assisted peritoneal dialysis programs identified in 20 jurisdictions. Two categories emerged for models of assisted peritoneal dialysis on the basis of type of assistance: health care and non–health care professional assistance. Reported outcomes were heterogeneous, ranging from patient-level outcomes of survival, to resource use and transfer to hemodialysis; however, the comparative effect of assisted peritoneal dialysis was unclear. In two qualitative studies examining the patient experience, the maintenance of independence was identified as an important theme.ConclusionsReported outcomes and quality were heterogeneous, and relative efficacy of assisted peritoneal dialysis could not be determined from included studies. Although the patient voice was under-represented, suggestions to improve assisted peritoneal dialysis included using a person-centered model of care, ensuring continuity of nurses providing the peritoneal dialysis assist, and measures to support patient independence. Although attractive elements of assisted peritoneal dialysis are identified, further evidence is needed to connect assisted peritoneal dialysis outcomes with programmatic features and their associated funding models.

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Urea is the Best Molecule to Target Adequacy of Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.1177/089686080002002s12 ◽

2000 ◽

Vol 20 (2_suppl) ◽

pp. 58-64 ◽

Cited By ~ 1

Author(s):

Frank A. Gotch

Keyword(s):

Peritoneal Dialysis ◽

Body Surface ◽

Residual Renal Function ◽

Dialysis Dose ◽

Surface Areas ◽

Wide Range ◽

Anephric Patients ◽

Dialysis Outcomes ◽

Two Parameters ◽

Urea Distribution Volume

For hemodialysis, a large base of data shows the validity of modelling the dialysis dose and reliably estimating protein intake from equilibrated Kt/V urea (eKt/VU), the total dialyzer urea clearance provided during each treatment divided by the urea distribution volume. An eKt/VU of 1.05 thrice weekly is judged adequate, but is still under study. In continuous ambulatory peritoneal dialysis (CAPD), two dosage criteria are widely recognized: continuous (“standard”) Kt/VU (stdKt/VU = 2.0 weekly), and total creatinine (Cr) clearance normalized to body surface area (KCrT = 70 L/week/1.73 m2). The CANUSA study concluded that a stdKt/VU of 2.1 and a KCrT of 70 L/week/1.73 m2 gave equivalent clinical outcomes. The Dialysis Outcomes Quality Initiative (DOQI) recommends values of 2.0 and 60 L/ week/1.73 m2 respectively. An analysis of these two parameters for males and females over a wide range of body surface areas (BSAs) was done and the analysis showed: ( 1 ) The U and Cr dose criteria are incommensurable—that is, they can virtually never be achieved simultaneously in anephric patients. ( 2 ) The Cr criterion varies widely with the sex of the patient and with the BSA-dependent variation in stdKt/VU over a range of 2.1 to 3.0. ( 3 ) The U criterion always produces a KCrT < 60 L/week/1.73 m2 in females and 60 – 70 L/ week/1.73 m2 in males. With respect to U and Cr, the CANUSA results were concluded to be valid in patients with substantial residual renal function, but probably not applicable to anephric patients where the doses are clearly incommensurable.

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Obesity Is Associated with Worse Peritoneal Dialysis Outcomes in the Australia and New Zealand Patient Populations

Journal of the American Society of Nephrology ◽

10.1097/01.asn.0000091587.55159.5f ◽

2003 ◽

Vol 14 (11) ◽

pp. 2894-2901 ◽

Cited By ~ 135

Author(s):

S. P. McDonald

Keyword(s):

Peritoneal Dialysis ◽

New Zealand ◽

Dialysis Outcomes

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Peritoneal Dialysis Adequacy in Asia—Is Higher Better?

Peritoneal Dialysis International ◽

10.1177/089686080302302s14 ◽

2003 ◽

Vol 23 (2_suppl) ◽

pp. 65-68 ◽

Cited By ~ 4

Author(s):

Philip K.T. Li ◽

Cheuk-chun Szeto

Keyword(s):

Peritoneal Dialysis ◽

Mineral Metabolism ◽

Pressure Control ◽

Residual Renal Function ◽

Acid Base Balance ◽

Dialysis Adequacy ◽

Fluid Removal ◽

Base Balance ◽

Dialysis Outcomes ◽

Small Solute

Sufficient data are available to support the contention that renal and peritoneal clearances are not equivalent, and that loss of residual renal function (RRF) cannot be completely compensated by an increase in the exchange volume or frequency of peritoneal dialysis. When RRF is minimal (for example, renal Kt/V is 0.1 – 0.3), increasing the peritoneal Kt/V beyond the “conventional” value recommended by the Dialysis Outcomes Quality Initiative yields little additional clinical benefit. The cut-off peritoneal ( not total) Kt/V is possibly 1.6 – 1.7. However, delivery of peritoneal small-solute clearance below that cut-off level has a major detrimental effect on clinical outcome in CAPD patients with little RRF. Measures to preserve RRF therefore become an important goal in the treatment of CAPD patients. In short, with regard to RRF (renal Kt/V), higher is always better, and we should always try to preserve it. For peritoneal Kt/V, higher is better only up to a certain limit. The importance of aspects of adequate dialysis other than small-solute removal—especially fluid removal, blood pressure control, nutrition, acid–base balance, mineral metabolism, and anemia and lipid control—cannot be sufficiently emphasized.

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Effect of Liver Cirrhosis on the Outcomes of Peritoneal Dialysis

Peritoneal Dialysis International ◽

10.3747/pdi.2018.00247 ◽

2019 ◽

Vol 39 (6) ◽

pp. 502-508 ◽

Cited By ~ 1

Author(s):

Young Lee Jung ◽

Jae Yoon Park ◽

Chung Sik Lee ◽

Dong Ki Kim ◽

Chun-Soo Lim ◽

...

Keyword(s):

Liver Cirrhosis ◽

Peritoneal Dialysis ◽

Exit Site Infection ◽

Common Causes ◽

Dialysis Outcomes ◽

Stage Renal Disease ◽

End Stage ◽

Event Rates ◽

Technique Failure

Background Peritoneal dialysis (PD) has become an increasingly important treatment modality for end-stage renal disease. However, application of PD in patients with liver cirrhosis (LC) and subsequent outcomes have not been thoroughly evaluated. Methods A total of 1,366 patients (≥ 18 years old) who started PD at 4 tertiary referral centers between January 2000 and December 2015 were initially reviewed. Among them, 45 patients with LC were finally analyzed (LC-PD). Using the multivariate Cox hazard ratio (HR) model, outcomes such as technique failure, infection, and mortality in patients with LC-PD were compared with those in non-LC-PD patients (non-LC-PD) or patients with LC who received hemodialysis (LC-HD). All of the patients were selected by 1:1 matching of age, sex, catheter insertion date, and diabetes mellitus. Results During the mean follow-up duration of 43 ± 35.8 months, 12 patients with LC-PD experienced technique failure, and this rate was similar to that of non-LC-PD patients. In evaluating infection episodes, the most common causes for peritonitis and exit-site infection were Escherichia coli (5.8%) and Staphylococcus aureus (19.3%), respectively; these event rates of LC-PD did not differ from those of non-LC-PD. The all-cause mortality rate of the LC-PD group was not different from that of the non-LC-PD and LC-HD groups. Conclusion Dialysis outcomes such as technique failure, infection, and mortality are not affected by the presence of LC. Accordingly, PD therapy is a good option in patients with LC.

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