Derived equations are not precise enough to predict the adequacy of creatinine clearance in peritoneal dialysis patients

2002 ◽  
Vol 40 (5) ◽  
pp. 1036-1044 ◽  
Author(s):  
Jamie P. Traynor ◽  
Siobhan K. McManus ◽  
Robert A. Mactier
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Dialysis Patients

Risk Factors for Early Mortality in U.S. Peritoneal Dialysis Patients: Impact of Residual Renal Function

2002 ◽  
Vol 22 (3) ◽  
pp. 371-379 ◽  
Author(s):  
◽  
Michael V. Rocco ◽  
Diane L. Frankenfield ◽  
Barbara Prowant ◽  
Pamela Frederick ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Creatinine Clearance ◽  
Residual Renal Function ◽  
Chronic Peritoneal Dialysis ◽  
Dialysis Patients ◽  
The Mean

Background Potential risk factors for 1-year mortality, including the peritoneal component of dialysis dose, residual renal function, demographic data, hematocrit, serum albumin, dialysate-to-plasma creatinine ratio, and blood pressure, were examined in a national cohort of peritoneal dialysis patients randomly selected for the Centers for Medicare and Medicaid Services End-Stage Renal Disease (ESRD) Core Indicators Project. Methods The study involved retrospective analysis of a cohort of 1219 patients receiving chronic peritoneal dialysis who were alive on December 31, 1996. Results During the 1-year follow-up period, 275 patients were censored and 200 non censored patients died. Among the 763 patients who had at least one calculable adequacy measure, the mean [± standard deviation (SD)] weekly Kt/V urea was 2.16 ± 0.61 and the mean weekly creatinine clearance was 66.1 ± 24.4 L/1.73 m2. Excluding the 365 patients who were anuric, the mean (±SD) urinary weekly Kt/V urea was 0.64 ± 0.52 (median: 0.51) and the mean (±SD) urinary weekly creatinine clearance was 31.0 ± 23.3 L/1.73 m2 (median: 26.3 L/1.73 m2). By Cox proportional hazard modeling, lower quartiles of renal Kt/V urea were predictive of 1-year mortality; lower quartiles of renal creatinine clearance were of borderline significance for predicting 1-year mortality. The dialysate component of neither the weekly creatinine clearance nor the weekly Kt/V urea were predictive of 1-year mortality. Other predictors of 1-year mortality ( p < 0.01) included lower serum albumin level, older age, and the presence of diabetes mellitus as the cause of ESRD, and, for the creatinine clearance model only, lower diastolic blood pressure. Conclusion Residual renal function is an important predictor of 1-year mortality in chronic peritoneal dialysis patients.

Association of Kt/V and Creatinine Clearance With Outcomes in Anuric Peritoneal Dialysis Patients

2008 ◽  
Vol 52 (6) ◽  
pp. 1122-1130 ◽  
Author(s):  
Linda Fried ◽  
Nasser Hebah ◽  
Fredric Finkelstein ◽  
Beth Piraino
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Dialysis Patients

Correlation between Fractional Reabsorption of Sodium and Erythropoietin dose in Peritoneal Dialysis Patients

2006 ◽  
Vol 26 (5) ◽  
pp. 581-586
Author(s):  
Shahrzad Ossareh ◽  
Iloise Moupas ◽  
Elias Thodis ◽  
Dimitrios G. Oreopoulos ◽  
Sandra Donnelly
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Negative Correlation ◽  
Transferrin Saturation ◽  
Sodium Reabsorption ◽  
Dialysis Patients ◽  
Renal Oxygen Consumption ◽  
Epo Deficiency ◽  
Renal Oxygen ◽  
Tissue Oxygen Pressure

Background Erythropoietin (EPO) deficiency of chronic renal failure (CRF) may be a functional consequence of decreased glomerular filtration rate and fractional reabsorption of sodium (FRNa). Decreased FRNa reduces renal oxygen consumption and increases tissue oxygen pressure, resulting in less EPO production. We hypothesized that, in CRF patients, there is a positive relationship between EPO production and FRNa and that, in such patients receiving EPO, a negative correlation is expected between FRNa and EPO dose. Methods Creatinine clearance, FRNa, serum iron, transferrin, transferrin saturation, ferritin, and intact parathyroid hormone (iPTH) levels were measured in 91 peritoneal dialysis patients. The correlation between EPO dose and FRNa was studied. Results Mean EPO dose was 7076 ± 4821 units/week and mean FRNa was 93.40% ± 6.14%. A negative correlation was found between EPO dose and FRNa ( r = -0.28, p < 0.01), and a positive correlation was found between both ferritin and iPTH and EPO dose ( r = 0.39, p < 0.001 and r = 0.35, p < 0.002 respectively). After adjusting for the effect of creatinine clearance, ferritin, and iPTH, there was still a significant correlation between EPO dose and FRNa ( p < 0.05). Conclusion In CRF patients there is a negative correlation between FRNa and EPO dose, which supports the hypothesis that EPO deficiency may be related to the decreased renal oxygen-consuming work of sodium reabsorption.

Peritoneal Dialysis Prescription Suitable for Children with Anuria

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 153-158
Author(s):  
Masataka Honda
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Poor Prognosis ◽  
Volume Overload ◽  
Dialysis Patients

Peritoneal dialysis patients with anuria have a poor prognosis because of uremia and volume overload. In the present paper, I discuss a suitable prescription for children with anuria. The discussion begins with the principles of prescription from the viewpoint of guidelines. Next, I present prescription and adequacy in children with regard to Kt/V urea, creatinine clearance, phosphorous, and ultrafiltration. Finally, I discuss how to prescribe for anuric children.

P1209ROLE OF NTPROBNP IN LONG-TERM PERITONEAL DIALYSIS PATIENTS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Luisa Pereira ◽  
Ana Rita Martins ◽  
Anabela Malho Guedes ◽  
Patricia Matias ◽  
Patricia Branco
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Cardiac Dysfunction ◽  
Cardiovascular Events ◽  
Hospital Admissions ◽  
Left Ventricular ◽  
Cardiac Insufficiency ◽  
Dialysis Patients ◽  
Fluid Removal

Abstract Background and Aims Plasma N-terminal fragment of pro brain natriuretic peptide (NTproBNP) concentration is elevated in cardiovascular diseases such as congestive heart failure, where increased levels of NTproBNP indicate cardiac dysfunction, hypervolemia, and higher risk of hospitalization and death. These associations have also been studied in patients with chronic kidney disease (CKD), where NTproBNP value remains controversial, especially in long-term peritoneal dialysis (PD) patients with respect to its pathophysiologic implications. This study aim was to determine whether NTproBNP was a predictor of hospital admissions and cardiovascular events among patients on automated (APD) and continuous (CAPD) ambulatory peritoneal dialysis. Methods This was a cross-sectional study which included stable patients from two Peritoneal Dialysis Units. Plasma NTproBNP concentration was measured in stable adult peritoneal dialysis patients attending for routine assessments on PD outpatient clinic. In all patients, demographic variables, clinical and other laboratory parameters were recorded and analyzed. Descriptive statistics was performed. Groups were compared using independent t-test for comparison of continuous variables and Chi square test for categorical variables. In order to evaluate relationship between NTproBNP and the other variables multivariate logistic regression and Pearson bivariate analysis were used. Results The study enrolled 70 patients (male/female 44/26; mean age 55.3±14.6 years; APD/CAPD 25/45; PD duration 28±24.2months). One third (31.4%) of the patients was diabetic, 12.9% presented cardiac insufficiency and 20% had cardiovascular disease. Pearson bivariate correlation analysis revealed that patients with higher weekly kt/v (p=0.039), total fluid removal (diuresis and ultrafiltration) (p=0.027) and total weekly creatinine clearance (p=0.007) had lower NTproBNP values. These patients had also significant lower plasmatic creatinine and phosphorus levels. We found no significant association with residual kidney function, peritoneal transport (D/P creatinine), serum albumin levels and c-reactive protein. We also found that patients with higher NTproBNP levels had significantly more cardiovascular events (p=0.010) and a trend for more common hospital admissions (p=0.066). There were no significant differences regarding NTproBNP between the two modalities of peritoneal dialysis (APD and CAPD patients) or in patients who were PD first. As expected, patients with cardiac dysfunction had significant higher NTproBNP values (p=0.004). Diabetic patients had higher NTproBNP levels, althought this difference was not significant. Conclusion Despite the inconsistency in the NTproBNP value among long-term PD patients, results from most studies concur that NTproBNP levels are closely associated with left ventricular dysfunction, morbidity and mortality in these patients. In our study, patients with higher NTproBNP levels had more cardiovascular events and a trend for more common hospital admissions. Regular monitoring of NTproBNP levels among PD patients may be useful for providing care for these patients. Plus, NTproBNP was associated with better PD efficacy, greater fluid removal and higher creatinine clearance, reinforcing clinical relevance of PD optimization. These results require confirmation in a prospective study.

Body Surface Area Limitations in Achieving Adequate Therapy in Peritoneal Dialysis Patients

1996 ◽  
Vol 16 (6) ◽  
pp. 617-622 ◽  
Author(s):  
Michael V. Rocco
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Surface Area ◽  
Body Surface Area ◽  
Body Surface ◽  
High Dose ◽  
Dialysis Patients ◽  
Ultrafiltration Rate ◽  
Peritoneal Equilibration Test ◽  
Transport Type

Objective To estimate the maximal body surface area (BSA) at which an uric chronic peritoneal dialysis patients can achieve adequate peritoneal dialysis using a variety of continuous ambulatory peritoneal dialysis (CAPD) and cycler regimens. Adequate dialysis was defined as a creatinine clearance of either 60 L/week/1.73 m2 or 70 L/ week/1.73 m2. Design Calculation of daily peritoneal creatinine clearances using standard formulas. For CAPD patients, creatinine clearance was calculated using published values for dialysate-to-plasma ratios for creatinine (DIP cr) measured over a 24-hour period and assuming a daily ultrafiltration rate of 1.5 to 2.0 L/day. For cycler patients, creatinine clearance was calculated for both one and two-hour dwell volumes, using published values for DIP cr from the peritoneal equilibration test and assuming a daily ultrafiltration rate of 2.0 L/day. All clearances were corrected to a normalized body surface area of 1.73 m2. Results For CAPD patients, 2– L dwell volumes can provide a weekly creatinine clearance of 60 L/week/1.73 m2 in patients with BSA < 1.45 m2 in the high transporter group and with BSA < 1.2 m2 in the low-average transporter group. Increasing dwell volume from 2.0 to 2.5 L increases these BSA limits in the four transport groups by 0.2 0.3 m2. Cycler therapy is not a viable option for patients in the low transporter group, and this therapy can achieve adequate creatinine clearances in patients in the low-average transport group only with large dwell volumes and in patients with BSA < 1.55 m2. However, in the high-average and high transporter groups, cycler therapy provides for superior creatinine clearances compared to CAPD patients using similar dwell volumes. Conclusions Adequate creatinine clearances in anuric patients are most likely to be achieved in patients with BSA > 2.0 m2 if they have high-average or high transport characteristics and are receiving cycler therapy with large dwell volumes and at least one daytime dwell. However, adequate creatinine clearances may be difficult to achieve in an uric patients who have a large BSA an d a low or low-average transport type, regardless of peritoneal dialysis modality. These patients should be considered for either high-dose peritoneal dialysis (multiple daytime and nighttime exchanges) or hemodialysis therapy.

Intermediate Outcomes by Race and Ethnicity in Peritoneal Dialysis Patients: Results from the 1997 ESRD Core Indicators Project

2000 ◽  
Vol 20 (3) ◽  
pp. 328-335 ◽  
Author(s):  
◽  
Michael V. Rocco ◽  
Diane L. Frankenfield ◽  
Pamela R. Frederick ◽  
Jacqueline Pugh ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Race And Ethnicity ◽  
Minority Group ◽  
Health Care Financing ◽  
Multivariate Logistic Regression Analysis ◽  
The United States ◽  
Dialysis Patients ◽  
Dialysis Adequacy ◽  
Intermediate Outcomes

Background Hispanics are the fastest growing minority group in the United States, and approximately 10% of all end-stage renal disease (ESRD) patients are Hispanic. Few data are available, however, regarding dialysis adequacy and anemia management in Hispanic patients receiving peritoneal dialysis in the U.S. Methods Data from the Health Care Financing Administration (HCFA) ESRD Core Indicators Project were used to assess racial and ethnic differences in selected intermediate outcomes for peritoneal dialysis patients. Results Of the 1219 patients for whom data were available from the 1997 sample, 9% were Hispanic, 24% were non-Hispanic blacks, and 59% were non-Hispanic whites. Hispanics were more likely to have diabetes mellitus as a cause of ESRD compared to blacks or whites, and both Hispanics and blacks were younger than white patients (both p < 0.001). Although whites had higher weekly Kt/V and creatinine clearance values compared to blacks or Hispanics ( p < 0.05), blacks had been dialyzing longer ( p < 0.01) and were more likely to be anuric compared to the other two groups ( p < 0.001). Blacks had significantly lower mean hematocrit values ( p < 0.001) and a greater proportion of patients who had a hematocrit level less than 28% ( p < 0.05) compared to Hispanics or whites, despite receiving significantly larger weekly mean epoetin alfa doses ( p < 0.05) and having significantly higher mean serum ferritin concentrations ( p < 0.01). Multivariate logistic regression analysis revealed significant differences by race/ethnicity for experiencing a weekly Kt/V urea < 2.0 and hypertension, but not for other intermediate outcomes examined (weekly creatinine clearance < 60 L/week/1.73 m2, Hct < 30%, and serum albumin < 3.5/3.2 g/dL). Conclusion Hispanics had adequacy values similar to blacks and anemia parameters similar to whites. Additional studies are needed to determine the etiologies of the differences in intermediate outcomes by racial and ethnic groupings in peritoneal dialysis patients.

scholarly journals Beta-trace protein as a potential biomarker of residual renal function in patients undergoing peritoneal dialysis

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sebastian Schwab ◽  
Carola Ellen Kleine ◽  
Dominik Bös ◽  
Sylvie Bohmann ◽  
Christian P. Strassburg ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Residual Renal Function ◽  
Dialysis Patients ◽  
Potential Biomarker ◽  
Weight Protein ◽  
Low Molecular Weight Protein ◽  
Residual Diuresis

Abstract Background Residual renal function is closely linked to quality of life, morbidity and mortality in dialysis patients. Beta-trace protein (BTP), a low molecular weight protein, has been suggested as marker of residual renal function, in particular in patients on hemodialysis. We hypothesized that BTP also serves as a marker of residual renal function in pertioneal dialysis patients. Methods In this study 34 adult patients on peritoneal dialysis were included. BTP, creatinine, cystatin C and urea concentrations were analyzed simultaneously in serum and dialysate to calculate renal and peritoneal removal of the analytes. Results In peritoneal dialysis patients with residual diuresis, mean serum BTP was 8.16 mg/l (SD ± 4.75 mg/l). BTP correlated inversely with residual diuresis (rs = − 0.58, p < 0.001), residual creatinine clearance (ClCr) (rs = − 0.69, p < 0.001) and total urea clearance (Clurea) (rs = − 0.56, p < 0.001). Mean peritoneal removal of BTP was 3.36 L/week/1.73m2 (SD ± 1.38) and mean renal removal 15.14 L/week/1.73m2 (SD ± 12.65) demonstrating a significant renal contribution to the total removal. Finally, serum BTP inversely correlated with alterations in residual diuresis (r = − 0.41, p = 0.035) and renal creatinine clearance over time (r = − 0.79, p = p < 0.001). Conclusion BTP measurement in the serum may be a simple tool to assess residual renal function in peritoneal dialysis patients.

Solute Clearance Approach to Adequacy of Peritoneal Dialysis

1996 ◽  
Vol 16 (5) ◽  
pp. 457-470 ◽  
Author(s):  
John M. Burkart ◽  
Martin Schreiber ◽  
Stephen M. Korbet ◽  
David N. Churchill ◽  
Richard J. Hamburger ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Peritoneal Dialysis ◽  
Relative Risk ◽  
Creatinine Clearance ◽  
Current Knowledge ◽  
Dialysis Patients ◽  
Risk Of Death ◽  
Relative Risk Of Death ◽  
The Relationship ◽  
Solute Clearance

To investigate the effect of dialysis prescription on patient outcome for peritoneal dialysis patients, the relationship between total solute clearance and the relative risk of death has been investigated. Preliminary studies have suggested that more clearance is better and that patient outcome is predicted by total solute clearance. The recently published Canada-U.S.A. (CANUSA) multicenter study, evaluating adequacy of dialysis and nutrition in peritoneal dialysis patients, has further defined this relationship. Although these publications allow us to establish guidelines for the treatment of peritoneal dialysis patients, they also define the limitations of our knowledge and raise new questions. In this article we review our current knowledge regarding the predicted value of total solute clearance with patient outcome and nutritional status. Furthermore, we attempt to outline a practical approach for optimizing total solute clearance in peritoneal dialysis patients. Based on a review of the published literature and clinical recommendations, we feel that the minimal target total solute clearance for continuous forms of peritoneal dialysis is a weekly total KTN > 2.0 and/or a weekly total creatinine clearance >60 L/week/1.73 m2. For intermittent therapies, a weekly total KTN > 2.2 and/or a weekly total creatinine clearance >70 L/week/1.73 m2 is recommended.

scholarly journals Comparison of icodextrin and glucose solutions for long-dwell exchange in continuous ambulatory peritoneal dialysis patients; a preliminary study

2018 ◽  
Vol 8 (2) ◽  
pp. 65-70
Author(s):  
Fatemeh Yaghoubi ◽  
Sudabeh Alatab ◽  
Iraj Najafi
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Sample Size ◽  
Membrane Transport ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Urine Volume ◽  
Dialysis Patients ◽  
Clinical Observations ◽  
Preliminary Study ◽  
Transport Type

Introduction: Icodextrin is widely used in peritoneal dialysis (PD) and several clinical observations suggest the superiority of icodextrin compared with 4.25% dextrose in optimizing peritoneal ultrafiltration (UF). However this solution has been introduced to our PD centers over the last two years. Objectives: In this study we aimed to evaluate the effects of employment of this solution in our PD patients. Patients and Methods: The study was carried out in two Iranian PD centers (Shafa and Shariati centers). We included 29 established patients (12 male and 17 female, mean age 58.9 ±11.1 years) who used icodextrin for the long-dwell exchange for last 6 months. Clinical data were collected at baseline and 6 months after icodextrin administration. Results: When the data between baseline and after 6 months of icodextrin administration was evaluated, we found no significant change in evaluated parameters including 24 hours UF, 24 hours urine volume, membrane transport type, Kt/V and creatinine clearance was observed. Conclusion: Icodextrin for the long-dwell exchange did not improve the creatinine clearance despite producing, a non-significant increase in 24-hour UF, after 6 months. Due to low proportion of patients and high inter-patients variability we cannot reach a robust conclusion. Studies with bigger sample size involving several PD centers are necessary to further address this subject.

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