P1145ADEQUACY AND SURVIVAL IN PERITONEAL DIALYSIS: TEN YEARS EXPERIENCE

Figure: Background and Aims in Italy only a minority of uremic patients perform peritoneal dialysis (PD). In dialysis centers where PD is practiced and proposed the prevalence is no more than 23%. Proposed advantages of PD over HD are a more preserved Residual renal function (RRF), that has been associated with better survival, and better Quality of life (Qol) due to possible more preservation of previous lifestyle, independence, possibility of traveling, and flexibility. Incremental peritoneal dialysis is a promising way to further improve Qol and to preserve RRF. Lastly, PD is less expensive than HD. Aim of this study has been to retrospectively evaluate our ten-years experience of PD treatment on survival, dialysis adequacy, preservation of RRF and nutrition in uremic patients followed at our Dialysis Center. Method We retrospectively evaluated all the incident patients that started PD treatment due to uremia from 01-01-2008 to 31-12-2018 at the U.O. Nephrology ASST Spedali Civili of Brescia. The exclusion criteria were time of dialysis treatment less than 3 months and absence of previous dialytic treatment or kidney transplantation. For each patient anthropometric, clinical-anamnestic data and comorbidities at dialysis start were recorded. Data on dialysis adequacy, nutrition, RRF and PD dialysis modality performed were also recorded. Results During the observation period 329 patients started PD. 60 were excluded due to follow-up of less than 3 months. Therefore, 269 patients (males 160, 59%) were studied. The average age was 65±16 years, BMI 24±4 kg/m2. Comorbidities were: hypertension (87%), diabetes mellitus (32%), cerebral vascular disease (26%) and ischemic heart disease (25%). The mean duration of dialysis treatment was 2.1±1.5 years. At the end of ten-years follow-up 24% of patients have had a kidney transplant, 18% were on PD treatment, 17% have had a shift towards HD, 39% had died. The main causes of death were: infection (39%) and cardiovascular disease (31%). The most common dialysis modality performed was APD (61%); CAPD was performed in 39% of pts. Dialysis modality (CAPD; APD), nutrition parameters (PNA; BMI), as well as RRF, expressed as an average value during follow-up, are shown in Figure 1. 81 patients (30%) were treated with incremental PD; 85% of them with manual exchanges. The comparison of dialysis parameters between incremental PD and standard PD are shown in Figure 2. Multivariate analysis with survival as dependent variable (Figure 3), showed that age, diabetes mellitus, and low wKt/V were independently associated with an increased risk of mortality. Diuresis volume and male gender were protective factors. No independent influence on mortality of the dialysis treatment modality was found. Conclusion In this ten-years experience of patients undergoing PD at our Center, incremental PD seems to be a protective factor for the maintenance of a preserved diuresis and better dialysis adequacy, and these factors are associated with better survival of the patients.

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P1135WHETHER USPD PATIENTS ARE SUITABLE FOR INCREMENTAL PERITONEAL DIALYSIS:YES OR NO?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1135 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Wenjing Zhang ◽

Jia LV ◽

Lan Li ◽

Zhigang Wang ◽

Dapeng Hao ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Urine Volume ◽

Residual Renal Function ◽

Dialysis Dose ◽

Dialysis Adequacy ◽

Exit Site Infection ◽

Full Dose ◽

Mechanical Complications

Abstract Background and Aims Incremental Peritoneal Dialysis (IPD) is the practice of initiating PD exchange less than four times a day in consideration of residual renal function (RRF). More clinical studies have confirmed the feasibility and effectiveness of IPD, especially in the protection of residual renal function, which is obviously superior to full-dose PD. Urgent-start peritoneal dialysis (USPD) is a popular PD method. Due to lack of pre-dialysis education, most of patients who were newly diagnosed with ESRD in China chose USPD. Well, can incremental peritoneal dialysis be used for USPD patients when starting dialysis? Compared to full-dose PD, whether incremental PD affects the residual renal function in USPD patients? Here we report the first study of incremental peritoneal dialysis’s effect on residual renal function. Method A retrospective analysis of medical records was performed on 169 patients who received USPD from August 2008 to March 2017. Patients were divided into 2 groups according to dialysis dose: incremental PD(i-PD) group (dialysis dose were less than or equal to 6000ml or 3 exchanges per day) and full-dose PD(f-PD) group (dialysis dose were great than or equal to 8000ml or 4 exchanges per day). The demographics, clinical biochemical indexes, dialysis dose, urine volume, dialysis ultrafiltration volume, RRF, dialysis adequacy, peritoneal dialysis infection complications, mechanical complications and survival rates were compared between two groups in 1 year follow-up. Results: (1).A total of 169 patients were enrolled, including 111 patients (average age 45.01±12.84 years) in i-PD group and 58 patients (average age 43.5±15.62 years) in f-PD group. The demographics and clinical biochemical indexes in the two groups before peritoneal dialysis were similar (P>0.05). (2).During the follow-up period, the dialysis dose in f-PD group(8034.48±262.61ml/d, 8080.00±395.80ml/d, 8155.17±523.21ml/d, 8051.72±906.55ml/d) were more than those in i-PD group(5891.89±528.31ml/d, 6159.57±1185.06ml/d, 6468.47±1588.71ml/d, 6900.90±1543.05ml/d), P<0.05. And the dialysis adequacy in both groups were up to standard: the total Kt/V (i-PD group: 1.96±0.56, 2.01±0.70, 2.02±0.55, 1.90±0.52; f-PD group: 2.18±0.47, 2.22±0.55, 2.05±0.44, 2.03±0.42) were greater than 1.7 and the total Ccr (i-PD group: 79.39±29.75, 79.02±25.11, 78.26±30.00, 73.09±29.14; f-PD group: 89.78±29.89, 91.54±35.56, 82.38±29.27, 72.96±23.75) were greater than 60L. (3).During the whole follow-up period, the residual renal function between two groups had no statistically significant(i-PD group: 3.96±2.52ml/min, 3.46±1.95ml/min, 3.58±2.85ml/min, 2.91±2.33ml/min; f-PD group: 4.31±4.83ml/min, 3.45±2.36ml/min, 3.16±2.15ml/min, 2.36±1.65ml/min), P>0.05. (4).During the whole follow-up period, the blood pressure control, correction of anemia, and correction of calcium and phosphorus abnormalities were also similar in both groups, P>0.05. (5).At 1-month and 6-month, the urine volume were higher in i-PD group(1024.33±492.91ml/d, 1017.03±571.66ml/d) than those in f-PD group(782.93±415.89ml/d, 788.27±491.02ml/d), P<0.05. The dialysis ultrafiltration volume in f-PD group (481.67±723.69ml/d, 632.77±687.89ml/d, 338.87±963.14ml/d, 750.43±849.69ml/d) were higher than those in i-PD group(343.30±520.00ml/d, 495.70±916.76ml/d, 341.78±925.57ml/d, 439.65±1297.13ml/d) during the whole follow-up period, but the differences were not statistically significant (P>0.05). (6).The exit-site infection, peritonitis, mechanical complications and technical survival were similar between the two groups (P>0.05). Conclusion Incremental peritoneal dialysis will not cause rapid decline of residual renal function in USPD patients, and the dialysis effect and complications are similar to full-dose peritoneal dialysis. Therefore, we recommend that USPD patients can be treated by incremental peritoneal dialysis.

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Factors Associated with Sudden Death in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080902900109 ◽

2009 ◽

Vol 29 (1) ◽

pp. 58-63 ◽

Cited By ~ 4

Author(s):

Kai Ming Chow ◽

Cheuk Chun Szeto ◽

Bonnie Ching-Ha Kwan ◽

Kwok Yi Chung ◽

Chi Bon Leung ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Function ◽

Peritoneal Dialysis ◽

Blood Transfusion ◽

Sudden Death ◽

Mineral Metabolism ◽

Residual Renal Function ◽

Alphabetical Order ◽

Dialysis Adequacy ◽

Dialysis Unit

Background Relatively little is known of the epidemiology and predictors of sudden death in peritoneal dialysis (PD) populations. We aimed to identify the risk factors of sudden death among PD subjects. Methods To explore clinical correlates of sudden death in PD patients, we conducted a population-based case-control study using data from a single dialysis unit. Cases ( n = 24) were defined as all PD patients that met the criteria for sudden death during January 2003 through December 2006. We also selected 48 control subjects that were selected from the prevalent PD patient name list compiled in alphabetical order. Data on the hemoglobin, potassium, and calcium levels, residual renal function, dialysis adequacy, cardiovascular risks, comorbid conditions, concurrent use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and erythropoietin, electrocardiographic and echocardiographic findings were extracted from case notes and computer records. Confounders were controlled by logistic regression. Results Over a period of 4 years, 24 PD patients (mean age 61.4 ± 9.5 years, median duration of dialysis 3.1 years) experienced sudden death. Univariate analyses showed that patients that died suddenly were more likely to be male and to have diabetes mellitus, a history of smoking, and a lower small solute clearance as measured by Kt/V. Cases of sudden death were also more likely to have received blood transfusion within the previous 1 year. There were no significant differences between patients and controls for residual renal function, serum potassium levels, control of blood pressure and mineral metabolism, or hemoglobin levels. Multivariate regression analysis confirmed independent association between recent blood transfusion and increased odds of sudden death [adjusted odds ratio (OR) 5.18, 95% confidence interval (CI) 1.44 – 18.6]. Two other factors significantly associated with risk of sudden death were male gender (adjusted OR 4.16, 95% CI 1.14 – 15.2) and diabetes mellitus (adjusted OR 5.33, 95% CI 1.53 – 18.6). Conclusion This study shows that recent blood transfusion is associated with an increased likelihood of sudden death in PD patients. The mechanisms that underlie this observation are unclear.

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Rapid Change in Residual Renal Function Decline is Associated with Lower Survival and Worse Residual Renal Function Preservation in Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00211 ◽

2017 ◽

Vol 37 (4) ◽

pp. 477-481 ◽

Cited By ~ 6

Author(s):

Susie L. Hu ◽

Priyanka Joshi ◽

Mark Kaplan ◽

Judy Lefkovitz ◽

Andreea Poenariu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Function ◽

Peritoneal Dialysis ◽

Fold Increase ◽

Residual Renal Function ◽

Rapid Decline ◽

Dialysis Patients ◽

Risk Of Mortality ◽

Increased Risk

The survival advantage observed among peritoneal dialysis patients early on after dialysis initiation has been largely attributed to residual renal function (RRF) preservation due to higher baseline residual function and fewer comorbidities. We hypothesize that a rapid decline in RRF is associated with higher risk of anuria and mortality. In a retrospective cohort study of 581 subjects on peritoneal dialysis with longitudinal prevalent data, we assessed whether RRF change over time, in addition to baseline RRF, increased risk of mortality and anuria using Kaplan-Meier analysis and Cox proportional hazard analysis to control for known risk factors. Rapid RRF decline (≥ 0.09 decline) over a 12-month period was associated with a 2.6-fold increase in the risk of death (hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.66 – 4.07, compared with < 0.09 decline) and a 2-fold increase in anuria (HR 2.06, 95% CI 1.24 – 3.42). Each quartile of increasing severity of RRF decline over a 12-month period increased risk incrementally for death (2ndquartile: HR 3.04, CI 1.26 – 7.34; 3rdquartile: HR 4.01, CI 1.71 – 9.83; 4thquartile HR 5.78, CI 2.10 – 15.9) and generally for anuria (quartiles with HR 5.72 – 7.21). The escalating risk of mortality and anuria was greater for those with diabetes mellitus. In conclusion, rapid decline in RRF over a 12-month period increased the risk of mortality and likewise anuria, beyond previously established risk factors for mortality and anuria. The impact on mortality and RRF preservation was particularly severe for those with diabetes mellitus.

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MO688CALCIUM PHOSPHATE PRODUCT IN PERITONEAL DIALYSIS: A RISK FACTOR FOR TYPE I MEMBRANE FAILURE?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab101.0010 ◽

2021 ◽

Vol 36 (Supplement_1) ◽

Author(s):

Berfu Korucu ◽

Omer Faruk Akcay ◽

Galip Guz

Keyword(s):

Risk Factor ◽

Peritoneal Dialysis ◽

High Glucose ◽

Cox Regression ◽

Residual Renal Function ◽

Study Endpoint ◽

Type I ◽

Cox Regression Analysis ◽

Increased Risk

Abstract Background and Aims Type I membrane failure (T1MF), increased transport status with ultrafiltration, and solute removal inadequacy are among the most challenging issues in peritoneal dialysis (PD) continuity. Although quite common, the causes of T1MF are not fully understood. This study aims to identify risk factors associated with T1MF. Method This is a retrospective, single site, cohort study of incident adult peritoneal dialysis patients sampled between January 2000 and January 2020. Patients were classified as “increased transporters” who had two or more categories of a rise in peritoneal equilibration test (PET), and “stable transporters” who had had a rise of 1 or no categories from their baseline during follow-up. The four-hour dialysate/plasma creatinine ratio was used to classify PET categories. The study endpoint was five years for stable transporters, and at the time of two category rise in the PET test for increased transporters. Results Baseline demographics, diabetes frequency, residual renal function (RRF), non-phosphate baseline laboratory, parathormone levels, and PD modalities were similar between the increased transporters (n=48) and the stable transporters (n=93). Significantly more patients were using renin-angiotensin-aldosterone system (RAAS) blockers in stable transporters and high-glucose dialysates in increased transporters (p=0.03 and p<0.01). Icodextrin, calcitriol, calcium-based phosphate binder use, and the number of peritonitis episodes were similar between the groups. Increased transporters reached the endpoint in 3.9(±0.7) years. Increased transporters had a higher baseline phosphate than stable transporters (p=0.02). The frequency of patients with an RRF and groups’ mean RRF in ml were similar at the endpoint (p=0.37, p=0.13). Increased transporters had a significantly higher baseline and endpoint CaXP than stable transporters (p<0.01 and p=0.02). Baseline weekly peritoneal Kt/V and peritoneal creatinine clearance (PCrCl) were similar at baseline. Increased transporters had significantly lower endpoint peritoneal Kt/V and insignificantly lower endpoint PCrCl than stable transporters (p<0.01 and p=0.05). ΔUF was negative for increased transporters and positive for stable transporters. Age, diabetes, peritonitis episodes, RAAS blocker use, and PD modality were insignificant in Cox regression analysis. A CaXP of >55 was related to 2.51-fold, and high-glucose dialysates were associated with a 2.93-fold increased risk for a rise in transport status (p=0.01 and p<0.01). Mean follow-up was 7.0 (±3.9) years for stable transporters and 5.6 (±2.0) years for increased transporters. Technical survival was significantly higher in stable transporters (p=0.03). Conclusion Our study revealed a CaXP of >55 is a risk factor for a significant increase in transport status, presumably due to peritoneal calcification. The peritoneal Kt/V, PCrCl, and UF rates declined accordingly. The high-glucose dialysates are associated with a high risk in analyses. However, it is not possible to determine whether these solutions are the cause or the result of Type I membrane failure.

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Predictors of Decline of Residual Renal Function in New Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080302300311 ◽

2003 ◽

Vol 23 (3) ◽

pp. 276-283 ◽

Cited By ~ 85

Author(s):

David W. Johnson ◽

David W. Mudge ◽

Joanna M. Sturtevant ◽

Carmel M. Hawley ◽

Scott B. Campbell ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Renal Function ◽

Peritoneal Dialysis ◽

Body Surface ◽

Dietary Protein ◽

Protein Intake ◽

Residual Renal Function ◽

Dietary Protein Intake

♦ Objective The aim of this study was to prospectively evaluate the risk factors for decline of residual renal function (RRF) in an incident peritoneal dialysis (PD) population. ♦ Design Prospective observational study of an incident PD cohort at a single center. ♦ Setting Tertiary-care institutional dialysis center. ♦ Participants The study included 146 consecutive patients commencing PD at the Princess Alexandra Hospital between 1 August 1995 and 1 July 2001 (mean age 54.8 ± 1.4 years, 42% male, 34% diabetic). Patients with failed renal transplants ( n = 26) were excluded. ♦ Main Measurements Timed urine collections ( n = 642) were performed initially and at 6-month intervals thereafter to measure RRF. The development of anuria was also prospectively recorded. ♦ Results The mean (±SD) follow-up period was 20.5 ± 14.8 months. The median slope of RRF decline was –0.05 mL/minute/month/1.73 m2. Using binary logistic regression, it was shown that the 50% of patients with more rapid RRF loss (< –0.05 mL/min/month/1.73 m2) were more likely to have had a higher initial RRF at commencement of PD [adjusted odds ratio (AOR) 1.83, 95% confidence interval (CI) 1.39 – 2.40] and a higher baseline dialysate/plasma creatinine ratio at 4 hours (D/P creat; AOR 44.6, 95% CI 1.05 – 1900). On multivariate Cox proportional hazards model analysis, time from commencement of PD to development of anuria was independently predicted by baseline RRF [adjusted hazard ratio (HR) 0.81, 95% CI 0.60 – 0.81], D/P creat (HR 2.87, 95% CI 2.06 – 82.3), body surface area (HR 6.23, 95% CI 1.53 – 25.5), dietary protein intake (HR 2.87, 95% CI 1.06 – 7.78), and diabetes mellitus (HR 1.65, 95% CI 1.00 – 2.72). Decline of RRF was independent of age, gender, dialysis modality, urgency of initiation of dialysis, smoking, vascular disease, blood pressure, medications (including angiotensin-converting enzyme inhibitors), duration of follow-up, and peritonitis rate. ♦ Conclusions The results of this study suggest that high baseline RRF and high D/P creat ratio are risk factors for rapid loss of RRF. Moreover, a shorter time to the onset of anuria is independently predicted by low baseline RRF, increased body surface area, high dietary protein intake, and diabetes mellitus. Such at-risk patients should be closely monitored for early signs of inadequate dialysis.

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P1154EFFECTS OF SHORT-TERM HEMODIALYSIS WITH CENTRAL VENOUS CATHETER(HD-CVC) ON PATIENTS WITH URGENT-START PERITONEAL DIALYSIS(USPD)

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1154 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Wenjing Zhang ◽

Jia LV ◽

Zhigang Wang ◽

Lan Li ◽

Jiping Sun

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Central Venous Catheter ◽

Urine Volume ◽

Venous Catheter ◽

Residual Renal Function ◽

Central Venous ◽

Short Term ◽

Dialysis Adequacy

Abstract Background and Aims Urgent-start peritoneal dialysis (USPD) has gained increasing worldwide attention. Studies have suggested that USPD has many advantages concerning the early complications, survival rates and medical expenses. Due to the lack of pre-dialysis education, most patients newly diagnosed with ESRD in China have less knowledge about the dialysis methods, whether HD or PD. So, some patients choose to receive the short-term hemodialysis with central venous catheter (HD-CVC) before USPD. Whether the HD-CVC affected USPD, and whether it was necessary for ESRD patients without indications of emergency dialysis to undergo HD-CVC transition before USPD, were addressed. So we investigate the effects of the HD-CVC on urgent-start peritoneal dialysis. Method Retrospective analysis was performed on patients who received USPD from August 2008 to March 2017 in the first affiliated hospital of Xi'an Jiaotong University. According to whether hemodialysis and central venous catheterization were performed before PD, these patients were divided into two groups: USPD group (HD-CVC was not performed before PD) and HD-PD group (HD-CVC was given after admission, and then the PD catheterization was performed within 2 weeks ). The follow-up time was 1 year. The differences in clinical biochemical indexes, dialysis dose, urine volume, residual renal function, dialysis adequacy, peritoneal dialysis complications and technical survival rate between the two groups were observed. Results 1.A total of 482 patients were enrolled in this study, including 315 in the USPD group (average age 48.56±14.92 years) and 167 in the HD-PD group (average age 48.87±14.49 years). The demographics and clinical biochemical indexes (including creatinine, glomerular filtration rate, and blood potassium before admission) were similar between the two groups, and the differences were not statistically significant(P>0.05).2. After PD for 1month, residual renal function, UKt/V and TKt/V in the USPD group were significantly higher than those in the HD-PD group, blood urea nitrogen and creatinine were significantly lower than those in the HD-PD group (USPD group: 4.41±4.0ml/min, 0.79±0.44, 2.17±1.39, 17.79±4.96mmol/L, 663.15±182.03umol/L; HD-PD group: 3.67±2.39ml/min, 0.64±0.42, 1.92±0.55, 19.08±8.21 mmol/L, 711.02±280.3umol/L), and the differences were statistically significant (P<0.05, respectively).After PD for 6months, the urine volume in the USPD group were significantly higher than those in the HD-PD group(USPD group:964.84±539.95ml/d; HD-PD group 794.39±569.17ml/d), and the difference was statistically significant (P=0.002). 3. During the whole follow-up period, the exit-site infection rate, peritonitis infection rate, mechanical complications and technical survival rate were similar between the two groups, with no statistically significant difference (P>0.05,respectively). Conclusion Hemodialysis with central venous catheter before USPD affected the residual renal function and dialysis adequacy. HD-CVC as a pretreatment is not recommended to the end-stage renal disease patients who required PD but without the indication of emergency dialysis.

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Independent Effects of Renal and Peritoneal Clearances on the Mortality of Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080402400106 ◽

2004 ◽

Vol 24 (1) ◽

pp. 58-64 ◽

Cited By ~ 24

Author(s):

Cheuk-Chun Szeto ◽

Teresa Yuk-Hwa Wong ◽

Kai-Ming Chow ◽

Chi-Bon Leung ◽

Man-Ching Law ◽

...

Keyword(s):

Renal Function ◽

Peritoneal Dialysis ◽

Patient Survival ◽

Residual Renal Function ◽

University Teaching ◽

Dialysis Adequacy ◽

Protein Nitrogen ◽

Technique Survival ◽

Independent Effects

Objective Previous studies show that peritoneal Kt/V is an independent predictor of survival in anuric patients receiving continuous ambulatory peritoneal dialysis (CAPD). We studied whether peritoneal Kt/V has the same effect in CAPD patients with residual renal function. Design Observational cohort study. Setting Single dialysis center in a university teaching hospital. Patients New and prevalent CAPD patients. Methods We examined the 5-year follow-up results of our prospective study previously reported ( Kidney Int 2000; 58:400–7). A total of 270 CAPD patients were followed for up to 6 years. Dialysis adequacy indices, residual renal function, and nutritional data were monitored. Outcome Measures Primary outcomes included mortality and technique failure. Peritoneal Kt/V rather than total Kt/V was used for multivariate survival analysis. Results Average duration of follow-up was 35.1 ± 22.0 months. Average peritoneal Kt/V throughout the study was 1.59 ± 0.37; median residual glomerular filtration rate (GFR) 0.82 mL/minute. Five-year actuarial patient survival was 41.5%, and technique survival was 23.1%. Multivariate analysis showed that sex, age, duration of dialysis, presence of diabetes, serum albumin, dialysate-to-plasma creatinine ratio at 24 hours, peritoneal Kt/V, residual GFR, and normalized protein nitrogen appearance were independent factors of both actuarial patient survival and technique survival. For every 0.1 unit higher peritoneal Kt/V, relative mortality risk was 0.94 (95% CI 0.89 – 0.99, p = 0.03). When prevalent and new CAPD cases were analyzed separately, peritoneal Kt/V predicted survival only for prevalent CAPD patients. Conclusion We conclude that, in prevalent CAPD patients with relatively low levels of peritoneal clearance and residual renal function, a higher peritoneal Kt/V is associated with better survival. Peritoneal clearance below 1.6 – 1.7 likely has a major detrimental effect on the clinical outcome of CAPD patients with little residual renal function.

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Residual renal function and nutritional status in patients on continuous ambulatory peritoneal dialysis

Medicinski pregled ◽

10.2298/mpns0512576j ◽

2005 ◽

Vol 58 (11-12) ◽

pp. 576-581

Author(s):

Natasa Jovanovic ◽

Mirjana Lausevic ◽

Biljana Stojimirovic

Keyword(s):

Renal Failure ◽

Peritoneal Dialysis ◽

Nutritional Status ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Residual Renal Function ◽

Dialysis Treatment ◽

End Stage ◽

Underlying Diseases ◽

Anthropometric Markers

Introduction During the last years, an increasing number of patients with end-stage renal failure caused by various underlying diseases, all over the world, is treated by renal replacement therapy. Nutritional status Malnutrition is often found in patients affected by renal failure; it is caused by reduced intake of nutritional substances due to anorexia and dietary restrictions hormonal and metabolic disorders, comorbid conditions and loss of proteins, amino-acids, and vitamins during the dialysis procedure itself. Nutritional status significantly affects the outcome of patients on chronic dialysis treatment. Recent epiodemiological trials have proved that survival on chronic continuous ambulatory peritoneal dialysis program depends more on residual renal function (RRF) than on peritoneal clearances of urea and creatinine. Material and methods The aim of the study was to analyze the influence of RRF on common biochemical and anthropometric markers of nutrition in 32 patients with end-stage renal failure with various underlying diseases during the first 6 months on continuous ambulatory peritoneal dialysis (CAPD). The mean residual creatinine clearance was 8,3 ml/min and the mean RRF was 16,24 week in our patients at the beginning of the chronic peritoneal dialysis treatment. Results and conclusion During the follow-up, the RRF slightly decreased, while the nutritional status of patients significantly improved. Gender and age, as well as the leading disease and peritonitis didn't influence the RRF during the first 6 months of CAPD treatment. We found several positive correlations between RRF and laboratory and anthropometric markers of nutrition during the follow-up, proving the positive influence of RRF on nutritional status of patients on chronic peritoneal dialysis.

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Predictors of Faster Decline of Residual Renal Function in Taiwanese Peritoneal Dialysis Patients

Peritoneal Dialysis International ◽

10.1177/089686080802803s35 ◽

2008 ◽

Vol 28 (3_suppl) ◽

pp. 191-195 ◽

Cited By ~ 3

Author(s):

Chia-Te Liao ◽

Chih-Chung Shiao ◽

Jenq-Wen Huang ◽

Kuan-Yu Hung ◽

Hsueh-Fang Chuang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Renal Function ◽

Peritoneal Dialysis ◽

Clinical Laboratory ◽

Statistical Significance ◽

Univariate Analysis ◽

Residual Renal Function ◽

Measure Data ◽

Chi Square ◽

Artery Disease

⋄ Objective Loss of residual renal function (RRF) in peritoneal dialysis (PD) patients is a powerful predictor of mortality. The present study was conducted to determine the predictors of faster decline of RRF in PD patients in Taiwan. ⋄ Methods The study enrolled 270 patients starting PD between January 1996 and December 2005 in a single hospital in Taiwan. We calculated RRF as the mean of the sum of 24-hour urea and creatinine clearance. The slope of the decline of residual glomerular filtration rate (GFR) was the main outcome measure. Data on demographic, clinical, laboratory, and treatment parameters; episodes of peritonitis; and hypotensive events were analyzed by Student t-test, Mann–Whitney U-test, and chi-square, as appropriate. All variables with statistical significance were included in a multivariate linear regression model to select the best predictors ( p < 0.05) for faster decline of residual GFR. ⋄ Results All patients commencing PD during the study period were followed for 39.4 ± 24.0 months (median: 35.5 months). The average annual rate of decline of residual GFR was 1.377 ± 1.47 mL/min/m2. On multivariate analysis, presence of diabetes mellitus ( p < 0.001), higher baseline residual GFR ( p < 0.001), hypotensive events ( p = 0.001), use of diuretics ( p = 0.002), and episodes of peritonitis ( p = 0.043) independently predicted faster decline of residual GFR. Male sex, old age, larger body mass index, and presence of coronary artery disease or congestive heart failure were also risk factors on univariate analysis. ⋄ Conclusions Our results suggested that diabetes mellitus, higher baseline residual GFR, hypotensive events, and use of diuretics are independently associated with faster decline of residual GFR in PD patients in Taiwan.

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Residual renal function and blood count in patients on continuous ambulatory peritoneal dialysis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0612503j ◽

2006 ◽

Vol 134 (11-12) ◽

pp. 503-508

Author(s):

Natasa Jovanovic ◽

Mirjana Lausevic ◽

Biljana Stojimirovic

Keyword(s):

Renal Failure ◽

Renal Function ◽

Peritoneal Dialysis ◽

Chronic Renal Failure ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Blood Count ◽

Residual Renal Function ◽

Co Morbidity ◽

Positive Correlations

Introduction:Most of patients with chronic renal failure are affected by normochromic, normocytic anemia caused by different etiological factors. Anemia causes a series of symptoms in chronic renal failure, which can hardly be recognized from the uremic signs. Anemia adds to morbidity and mortality rates in patients affected by advanced chronic renal failure. Blood count partially improves during the first months after starting the chronic renal replacement therapy, in correlation with the quality of depuration program, with extension of erythrocyte lifetime and with hemoconcentration due to reduction of plasma volume. Recent trials found that higher residual renal function (RRF) significantly reduced co-morbidity, the rate and duration of hospitalization and risk of treatment failure. Objective: The aim of the study was to follow blood count parameters in 32 patients on chronic continuous ambulatory peritoneal dialysis (CAPD) during the first six months of treatment, to evaluate the influence of demographic and clinical factors on blood count and RRF, and to examine the correlation between RRF and blood count parameters. Method: A total of 32 patients affected by end-stage renal disease of different major cause during the first six months of CADP treatment were studied. RRF and blood count were evaluated as well as their relationship during the follow-up. Results: Blood count significantly improved in our patients during the first six months of CAPD treatment even if Hb and HTC failed to reach normal values. Iron serum level slightly decreased because of more abundant erythropoiesis and iron utilization during the first six months of treatment. RRF slightly decreased. After six months of CAPD treatment, the patients with higher RRF had significantly higher Hb, HTC and erythrocyte number and a lot of positive correlations between RRF and anemia markers were observed. Conclusion: After 6-month follow-up period, the patients with higher RRF had significantly higher blood count parameters, and several positive correlations between RRF and blood count markers were confirmed.

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