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

2008 ◽  
Vol 28 (3_suppl) ◽  
pp. 191-195 ◽  
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.

Rate of Decline of Residual Renal Function in Patients on Continuous Peritoneal Dialysis and Factors Affecting It

2000 ◽  
Vol 20 (4) ◽  
pp. 429-438 ◽  
Author(s):  
Manoj K. Singhal ◽  
Shaunmukhum Bhaskaran ◽  
Edward Vidgen ◽  
Joanne M. Bargman ◽  
Stephen I. Vas ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Renal Function ◽  
Multivariate Analysis ◽  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Outcome Measure ◽  
Residual Renal Function ◽  
Left Ventricular ◽  
Male Gender

Objective We analyzed residual renal function (RRF) in a large number of new peritoneal dialysis (PD) patients to prospectively define the time course of decline of RRF and to evaluate the risk factors assumed to be associated with faster decline. Study Design Single-center, prospective cohort study. Setting Home PD unit of a tertiary care University Hospital. Patients The study included 242 patients starting continuous PD between January 1994 and December 1997, with a minimum follow-up of 6 months and at least three measurements of RRF. Measurement All patients had data on demographic and laboratory variables, episodes of peritonitis and the use of aminoglycoside (AG) antibiotics, temporary hemodialysis, and number of radiocontrast studies. Adequacy of PD was measured from 24-hour urine and dialysate collection and peritoneal equilibration test using standard methodology. Further data on RRF was collected every 3 to 4 months until the patient became anuric (urine volume < 100 mL/day or creatinine clearance < 1.0 mL/min) or until the end of study in December 1998. Outcome Measure The slope of the decline of residual glomerular filtration rate (GFR) (an average of renal urea and creatinine clearance) was the main outcome measure. Risk factors associated with faster decline were evaluated by a comparative analysis between patients in the highest and the lowest quartiles of the slopes of GFR, and a multivariate analysis using a stepwise option within linear regression and general linear models. Results There was a gradual deterioration of residual GFR with time on PD, with 40% of patients developing anuria at a mean of 20 months after the initiation of PD. On multivariate analysis, use of a larger volume of dialysate ( p = 0.0001), higher rate of peritonitis ( p = 0.0005), higher use of AG ( p = 0.0006), presence of diabetes mellitus ( p = 0.005), larger body mass index (BMI) ( p = 0.01), and no use of antihypertensive medications ( p = 0.04) independently predicted the steep slope of residual GFR. Male gender, higher grades of left ventricular dysfunction, and higher 24-hour proteinuria were associated with faster decline on univariate analysis only. Conclusion Faster decline of residual GFR corresponds with male gender, large BMI, presence of diabetes mellitus, higher grades of congestive heart failure, and higher 24-hour proteinuria. Higher rate of peritonitis and use of AG for the treatment of peritonitis is also associated independently with faster decline of residual GFR. Whether the type of PD (CAPD vs CCPD/NIPD) is associated with faster decline of residual GFR remains speculative.

Factors Associated with Sudden Death in Peritoneal Dialysis Patients

2009 ◽  
Vol 29 (1) ◽  
pp. 58-63 ◽  
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.

Serum Chromium Levels are Higher in Peritoneal Dialysis than in Hemodialysis Patients

2019 ◽  
Vol 39 (4) ◽  
pp. 330-334 ◽  
Author(s):  
Leonid Feldman ◽  
Ilia Beberashvili ◽  
Ramzia Abu Hamad ◽  
Iris Yakov-Hai ◽  
Elena Abramov ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Medical Center ◽  
Univariate Analysis ◽  
Residual Renal Function ◽  
Chronic Dialysis ◽  
Multivariate Logistic Regression Model ◽  
Chromium Level ◽  
Serum Chromium ◽  
Dialysis Vintage

BackgroundAn elevation in serum chromium levels in individuals treated with renal replacement therapy has been previously described, but chromium levels have not been systematically studied in patients treated with different dialysis modalities. The aim of this study was to compare serum chromium levels in patients treated with chronic peritoneal dialysis (PD) and hemodialysis (HD).MethodsWe studied 169 chronic dialysis patients in a single medical center, of which 148 were treated with HD and 21 with PD. Serum chromium levels were measured by atomic absorption spectrometry. Residual renal function was accessed using a timed urine collection for the measurement of urine output and calculation of glomerular filtration rate (GFR).ResultsThe median (interquartile range) serum chromium level was significantly higher in patients treated with PD than in patients treated with HD: 5.00 (3.24 – 6.15) vs 1.83 (1.29 – 2.45) mcg/L, p < 0.001. In a univariate analysis, serum chromium level was associated with PD modality: Exp (B) 7.46 (95% confidence interval [CI] 2.1 – 26.4), p = 0.002. The association of PD modality with serum chromium level was even more significant using a multivariate logistic regression model: odds ratio (OR) 11.87 (95% CI 2.85 – 49.52), p = 0.001 after adjustment for age, gender, diabetes, smoking, dialysis vintage, use of diuretics, and residual renal function.ConclusionsIn patients treated with chronic dialysis, serum chromium levels are higher in patients treated with PD than in those treated with HD.

scholarly journals Risk Factors for Decline of Residual Renal Function in Children Treated with Peritoneal Dialysis

2016 ◽  
Vol 36 (6) ◽  
pp. 669-675 ◽  
Author(s):  
Maria Roszkowska-Blaim ◽  
Piotr Skrzypczyk
Keyword(s):  
Risk Factors ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Univariate Analysis ◽  
Residual Renal Function ◽  
Fluid Volume ◽  
First Year ◽  
Z Score ◽  
Glucose Load ◽  
Second Year

Background The aim of the study was to assess risk factors for residual renal function (RRF) decline in children during the first/second year of chronic peritoneal dialysis (PD). Methods The study group included 56 children with end-stage renal disease (ESRD) (age 10.13 ± 4.86 years), including 18 on continuous ambulatory PD (CAPD) and 38 on automated PD (APD), in whom we evaluated RRF (daily diuresis [mL/m2/24 h], residual glomerular filtration rate (rGFR) [mL/min/1.73 m2]), etiology of ESRD, PD fluid volume (mL/m2/24 h), glucose load (g/m2/24 h), ultrafiltration (mL/m2/24 h), peritoneal permeability (D/PCrea 4h, D/D0 Glu 4h), dialysis adequacy (twKt/V, twCCr [L/week/1.73 m2]), blood pressure (BP), biochemical parameters, and medications used. Duration of follow-up was 24 months. Results Mean diuresis before initiation of PD was 1,394.93 ± 698.37 (mL/m2/24 h), and mean rGFR was 7.41 ± 3.96 (mL/min/1.73 m2). The rate of daily diuresis decline was -529.34 ± 546.28 in the first year and -107.10 ± 291.54 (mL/m2/24 h) in the second year ( p = 0.005), and the rate of rGFR decline was -3.35 ± 3.73 in the first year and -1.63 ± 1.85 (mL/min/1.73 m2) in the second year ( p = 0.118). Eleven (19.64%) patients became anuric. In univariate analysis, the rate of daily diuresis decline in the first year was related to baseline diuresis ( r = -0.29, p = 0.031), proteinuria ( r = -0.43, p = 0.001), and systolic BP ( r = -0.31, p = 0.020); 12-month changes (Δ0 - 12) in PD fluid volume ( r = -0.37, p = 0.004), glucose load ( r = -0.28, p = 0.035), and ultrafiltration ( r = -0.38, p = 0.004); serum calcium-phosphorus product ( r = -0.41, p = 0.002); and Δ0 - 12 body mass index (BMI) Z-score ( r = 0.30, p = 0.024); while the rate of rGFR decline in the first year was related only to baseline rGFR ( r = -0.57, p < 0.001). In multivariate analysis, significant predictors of the rate of daily diuresis decline in the first year were baseline diuresis (P = -0.386, p < 0.001) and proteinuria (p = -0.278, p = 0.017), mean systolic BP Z-score (P = -0.237, p = 0.027), and age at the onset of PD (P = -0.224, p = 0.037), while predictors of the rate of rGFR decline were baseline rGFR (P = -0.607, p < 0.001) and baseline proteinuria (P = -0.225, p = 0.046). In the second year, the only predictors of the rate of rGFR decline were D/D0 Glu 4h ( r = 0.44, p = 0.033, univariate analysis) and rGFR at 12 months (P = -0.499, p = 0.044). Conclusion The most important risk factors for rapid RRF decline in children during the first year of chronic PD include higher baseline daily diuresis and proteinuria, and additional factors are systolic BP and age at the onset of PD; while high baseline GFR and low peritoneal transport status may be the only important factors during the second year.

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

2017 ◽  
Vol 37 (4) ◽  
pp. 477-481 ◽  
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.

scholarly journals Lower probability of patient survival with continuous peritoneal dialysis in the United States compared with Canada. Canada-USA (CANUSA) Peritoneal Dialysis Study Group.

1997 ◽  
Vol 8 (6) ◽  
pp. 965-971 ◽  
Author(s):  
D N Churchill ◽  
K E Thorpe ◽  
E F Vonesh ◽  
P R Keshaviah
Keyword(s):  
Diabetes Mellitus ◽  
United States ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Insulin Dependent Diabetes Mellitus ◽  
The United States ◽  
Residual Renal Function ◽  
Dependent Diabetes Mellitus ◽  
Insulin Dependent ◽  
Continuous Peritoneal Dialysis

In a prospective cohort study of 680 incident continuous peritoneal dialysis (PD) patients in North America, dialysis in the United States compared with Canada was associated with a relative risk (RR) of death of 1.93 (95% confidence interval [CI], 1.14 to 3.28). The 2-yr survival probability was 79.7% in Canada and 63.2% in the United States. This difference was not explained by race, age, gender, functional status, insulin-dependent diabetes mellitus, history of cardiovascular disease (CVD), nutritional status, or adequacy of dialysis. Other potential explanatory variables were further evaluated. These included severity of CVD, residual renal function, race, differential transfer to hemodialysis or transplantation, patient compliance, modality selection bias, and incidence of endstage renal disease requiring dialysis. Cardiovascular morbidity and peritonitis probabilities were compared. The CVD severity index was not different between countries; the RR risk associated with dialysis in the United States remained high at 1.87 (95% CI, 1.09 to 3.19). Residual renal function at initiation of dialysis was not different between countries. The 2-yr survival for Caucasians was 77% in Canada and 55% in the United States. There was no difference in the probability of transfer to hemodialysis or transplantation. The RR of a nonfatal cardiovascular event in the United States compared with Canada was 1.80 (95% CI, 1.21 to 2.67). There was no difference in time to first peritonitis. The observed to predicted creatinine ratio, as an estimate of compliance, was 1.13 in Canada and 1.00 in the United States. The prevalence of PD in the study centers was 48% in Canada and 22% in the United States. The incidence of new dialysis patients in 1992 was 100/million population in Canada compared with 211/ million in the United States. The survival difference is not explained by age, gender, insulin-dependent diabetes mellitus, nutritional status, or adequacy of dialysis. Neither is it explained by race, severity of CVD, transfer to hemodialysis, transplantation, or an estimate of compliance. The lower proportion of patients receiving PD in the United States may represent a selection bias of uncertain direction. The higher acceptance rate for dialysis in the United States may explain, in part, the greater cardiovascular morbidity and the decreased survival observed.

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

2003 ◽  
Vol 23 (3) ◽  
pp. 276-283 ◽  
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.

The Effect of Depressive Symptoms on Survival in Peritoneal Dialysis Patients

2004 ◽  
Vol 24 (3) ◽  
pp. 256-263 ◽  
Author(s):  
Rebecca Einwohner ◽  
Judith Bernardini ◽  
Linda Fried ◽  
Beth Piraino
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Depressive Symptoms ◽  
Serum Albumin ◽  
Cox Regression ◽  
Univariate Analysis ◽  
Residual Renal Function ◽  
Dialysis Patients ◽  
Single Measurement ◽  
Cox Regression Analysis

Objective There is little information on the relationship between depressive symptoms and survival in peritoneal dialysis (PD) patients. We examined whether a single measurement of depressive symptoms using a simple self-administered tool predicts survival. Design Screening test of depressive symptoms as a predictor of outcome. Setting Three dialysis centers in Southwestern Pennsylvania. Participants 66 adult PD subjects were screened in 1997–1998 for depression using the Zung scale. Main Outcome Measures Baseline data collection included assessments of comorbidity, residual renal function, total Kt/V, nPNA, previous renal transplant, and serum albumin. Outcomes were collected prospectively after completion of the depression survey to 12/01. Cox regression analysis of patient survival was performed using all cofactors with p < 0.05 on univariate analysis. Results One third of patients had depressive symptoms. Compared to nondepressed patients, depressive symptom patients were older (62.5 vs 52.5 years, p = 0.012), had borderline lower serum albumin levels (3.47 vs 3.70 g/dL, p = 0.058), and were more disabled (Karnofsky score 70 vs 90, p < 0.001), but had similar Kt/V, residual renal function, and previous time on PD at the point of the testing. Using multivariate analysis and controlling for comorbidity (using a measurement that includes diabetes mellitus and age) and serum albumin, the survival of patients with depressive symptoms was significantly reduced compared to nondepressed patients. Conclusion A single measurement of depressive symptoms using a simple self-administered test was an independent predictor of death in a cohort of PD patients, which extends observations in hemodialysis patients. Screening for depressive symptoms should be routine for dialysis patients, and those depressed should have thorough assessment and treatment. Whether treating depression will have an impact on survival is unclear and needs to be studied.

scholarly journals A Pilot Study Examining the Effects of Tolvaptan on Residual Renal Function in Peritoneal Dialysis for Diabetics

2015 ◽  
Vol 35 (5) ◽  
pp. 552-558 ◽  
Author(s):  
Takeyuki Hiramatsu ◽  
Akinori Hobo ◽  
Takahiro Hayasaki ◽  
Koki Kabu ◽  
Shinji Furuta
Keyword(s):  
Diabetes Mellitus ◽  
Renal Function ◽  
Peritoneal Dialysis ◽  
Pilot Study ◽  
Atrial Natriuretic Peptide ◽  
Natriuretic Peptide ◽  
Residual Renal Function ◽  
Volume Control ◽  
Control Group ◽  
Atrial Natriuretic

BackgroundFor patients with end-stage renal disease (ESRD), peritoneal dialysis (PD) serves as a possible renal replacement therapy. However, most PD patients, particularly those with ESRD and diabetes mellitus, reportedly discontinue PD early, resulting in shorter survival periods and poorer prognosis because of overhydration. Recently, the vasopressin-2 receptor antagonist tolvaptan was approved for volume control in patients with heart failure. The present study aimed to identify the effects of tolvaptan in diabetic PD patients.MethodsIn this pilot study, the tolvaptan group ( n = 12) were treated with 15 mg/day of tolvaptan 2 weeks after PD initiation and were prospectively analyzed for 1 year, and patients in the control group ( n = 12) did not receive tolvaptan and were retrospectively analyzed for 1 year. In addition to the biochemical tests, echocardiograms, serum atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels, peritoneal Kt/V, and creatinine clearance (CCr) were examined at baseline and at 6 and 12 months after PD initiation.ResultsIn the control group, the urine volume, renal Kt/V, and renal CCr levels consistently decreased; however, these parameters were stably maintained during the study period in the tolvaptan group. Atrial natriuretic peptide, CRP levels and the left ventricular mass index of the tolvaptan-treated group were significantly lower than those in the control group, whereas total protein and albumin levels were significantly higher at 6 and 12 months in the tolvaptan group. There were no obvious adverse effects.ConclusionsThese data suggest that tolvaptan may preserve residual renal function and improve volume control in PD patients with diabetes mellitus.

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