Weekly Clearances of Urea and Creatinine on CAPD and NIPD

1992 ◽  
Vol 12 (3) ◽  
pp. 298-303 ◽  
Author(s):  
Karl D. Nolph ◽  
Zbylut J. Twardowski ◽  
Prakash R. Keshaviah1
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Total Body Water ◽  
Clinical Implications ◽  
Urea Clearance ◽  
Short Cycle ◽  
Future Studies ◽  
Long Cycle ◽  
Total Body

Weekly creatinine clearance (Ccr) and weekly Curea/ v (kt/v) are popular indices for quantitating the amount of peritoneal dialysis provided. Studies were undertaken on 44 patients on continuous ambulatory peritoneal dialysis (CAPD) and 10 patients on nightly intermittent peritoneal dialysis (NIPD) to compare relationships of weekly creatinine clearance to weekly urea clearance (Curea) divided by total body water (v). With a long cycle therapy such as CAPD, the ratio of weekly Ccr to weekly kt/v is higher than with a short cycle technique, such as NIPD, in the same patient. If patients are shifted from CAPD to NIPD maintaining the same weekly kt/v, the weekly Ccr will decrease. If patients are shifted from CAPD to NIPD maintaining the same weekly Ccr, then the weekly kt/v will increase. The clinical implications of these observations are unknown, but should be kept in mind for future studies comparing CAPD and NIPD.

Weight Limitations for Weekly Urea Clearances Using Various Exchange Volumes in Continuous Ambulatory Peritoneal Dialysis

1994 ◽  
Vol 14 (3) ◽  
pp. 261-264 ◽  
Author(s):  
Karl D. Nolph ◽  
Richard A. Jensen ◽  
Ramesh Khanna ◽  
Zbylut J. Twardowski
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Outcome Measures ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Total Body Water ◽  
Theoretical Calculations ◽  
Plasma Urea ◽  
Graphic Form ◽  
Anephric Patients ◽  
Total Body

Objective To calculate the relationships of weekly KT/V urea to standard body weight with different exchange volumes (2, 2.5, or 3 L) for continuous ambulatory peritoneal dialysis (CAPD) in functionally a nephric patients and to display the results in graphic form. Design Theoretical calculations using previously measured 24-hour dialysate/plasma urea values in 77 CAPD patients and other defined components of weekly KT/V urea. Setting Measurements and calculations in theoretical patients doing standard CAPD with four daily exchanges. Patients Theoretical functionally anephric patients on standard CAPD as above. Interventions Theoretical calculations based on instillation of 2-, 2.5-, and 3-L exchange volumes. Main Outcome Measures Weekly urea clearances normalized to total body water (weekly KT/V urea). The values using different exchange volumes were related to standard body weight. Results Although a minimum recommended weekly KT/V urea target is arbitrary, the results illustrate the range of flexibility of CAPD relative to KT/V urea values with variations in exchange volume. The standard weights above which anephric patients on CAPD using four exchanges per day with 2-, 2.5-, and 3-L exchanges cannot reach a weekly KT/V urea target of 1.7, have been identified. The range of weekly KT/V urea levels possible with different exchange-volume programs has been graphically illustrated. Conclusions Weights above which a weekly KT/V urea of 1.7 cannot be reached in functionally anephric patients are 64, 77.6, and 91 kg for CAPD using 2-, 2.5-, and 3- L exchanges, respectively.

Nutritional Status of Patients Undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD)

1983 ◽  
Vol 3 (3) ◽  
pp. 138-141 ◽  
Author(s):  
Brigitte Heide ◽  
Andreas Pierratos ◽  
Ramesh Khanna ◽  
Jean Pettit ◽  
Raymond Ogilvie ◽  
...  
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Protein Intake ◽  
Biochemical Parameters ◽  
Total Body Potassium ◽  
Total Body ◽  
Over Time

Nutritional follow-up of 20 CAPD patients for 18–24 months showed a decrease in total body nitrogen, increase in total body potassium and body weight, and a decrease in protein intake over time. There was no correlation between changes in TBN and the biochemical parameters measured. Serial dietetic assessments and measurements of total body nitrogen as well as adherence to an adequate protein intake will assist in the prevention of malnutrition in CAPD patients.

Gender, degree of obesity, and discrepancy between urea and creatinine clearance in peritoneal dialysis.

1998 ◽  
Vol 9 (3) ◽  
pp. 497-499
Author(s):  
A H Tzamaloukas ◽  
D Malhotra ◽  
G H Murata
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Ideal Weight ◽  
Clearance Studies ◽  
Obese Subjects ◽  
The Difference ◽  
The Relationship ◽  
Linear Manner ◽  
One Way Anova

The effect of gender and degree of obesity on the size indicators V, used to normalize urea clearance (Kt/Vur), and body surface area (BSA), used to normalize creatinine clearance (Ccr), in peritoneal dialysis was studied by: (1) mathematical comparison of the formulae used to estimate V (Watson and Hume) with the Dubois formula used to estimate BSA in peritoneal dialysis; and (2) comparison of percent deviation of BSA (delta BSA%) and V (delta V%) from ideal weight estimates in 933 clearance studies performed in actual patients (555 in men and 378 in women on continuous ambulatory peritoneal dialysis). V was estimated by the Watson formulae and BSA by the Dubois formula in these studies. delta BSA% and delta V% were stratified in 10% increments in deviation of body weight from ideal (delta W%) in these studies. Mathematically, the relationship between V and BSA is not linear. In the same subject, as obesity develops (delta W% increases) and BSA increases in a linear manner, V increases exponentially. In addition, there are substantial differences in the relationship between V and BSA caused by gender. For the same height and BSA, men have a larger V than women. In the clearance studies performed in actual continuous ambulatory peritoneal dialysis patients, the difference between delta V% and delta BSA% increased significantly (P < 0.0001) from the wasted to the obese subjects by one-way ANOVA in both men and women. Normalization of urea and creatinine clearances by different size indicators creates two types of mathematical distortion in the relationship between the two clearances. One distortion is caused by the degree of obesity. The second distortion is caused by gender. Use of the same size indicator to normalize both urea and creatinine clearances would eliminate these distortions.

Six-Month Overnight Intraperitoneal Amino-Acid Infusion in Continuous Ambulatory Peritoneal Dialysis (CAPO) Patients-No Effect on Nutritional Status

1990 ◽  
Vol 10 (1) ◽  
pp. 79-84 ◽  
Author(s):  
Nicholas V. Dombros ◽  
Krystyne Prutis ◽  
Mathew Tong ◽  
G. Harvey Anderson ◽  
Joan Harrison ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Protein Intake ◽  
Statistical Significance ◽  
Caloric Intake ◽  
Skinfold Thickness ◽  
Amino Acid Infusion ◽  
Long Term Effect ◽  
Total Body

The long-term effect of an AA solution based on Tra-vasol®, a solution for total parenteral nutrition, given in-traperitoneally over a 6-month period was studied in 5 patients 22 to 75 years old, having been on continuous ambulatory peritoneal dialysis (CAPD) for 3 to 57 months. A low oral protein intake (<0.8 g/kg bw /day) and/or a low serum albumin «35 g/L) were used as inclusion criteria. Two liters of 1% AA solution were infused overnight, while a glucose Dianeal® was used for the other exchanges. During the study, BUN increased from 22.04 mM/L to 28.06 mM/L the first month and remained at these levels, indicating the increased protein intake. However, average oral total energy and protein intake, body weight (bw), serum creatinine, cholesterol, triglycerides, total proteins, albumin, transferrin, skinfold thickness, total body potassium, and plasma AA levels remained basically unchanged. The average total body nitrogen decreased from 1.746 to 1.554 Kg, but this decrease did not reach statistical significance (p > 0.05). We conclude that intraperitoneal overnight administration of 2 L of 1% AA based on Travasol® over 6 months did not improve the nutritional status of CAPD patients. This ineffectiveness might be due to the AA composition of the solution, the timing of administration, or to a low caloric intake and/or that our patients were not severely malnourished.

scholarly journals Impact of increasing dialysis volume on adequacy targets: a prospective study.

1997 ◽  
Vol 8 (8) ◽  
pp. 1304-1310 ◽  
Author(s):  
J Harty ◽  
H Boulton ◽  
M Venning ◽  
R Gokal
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Prospective Study ◽  
Creatinine Clearance ◽  
Renal Clearance ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Target Values ◽  
A Prospective Study ◽  
The Impact ◽  
Solute Clearance

Failure to achieve target values for both urea (Kt/V) and creatinine clearance has been associated with increased morbidity and mortality in continuous ambulatory peritoneal dialysis patients. The conventional continuous ambulatory peritoneal dialysis regimen, which uses four 2-L exchanges per day, has resulted in up to 40% of such patients failing to achieve proposed targets for weekly Kt/V of 1.7 and weekly creatinine clearance (WCC) of 50 L. In a prospective study, the impact of increasing prescribed volumes by 0.5 L per exchange was evaluated on attaining urea and creatinine clearance targets over a 1-yr period. At 1 yr, 17 patients remaining on the increased dialysis prescription were compared with 18 patients remaining on an unchanged regimen. The mean increase in daily prescribed volume was 1.5 L (22%). This resulted in a significant increase in both peritoneal dialysis Kt/V (1.59 to 1.78 L = 12%) and peritoneal dialysis WCC (45.8 to 50.1 L = 10%) by 1 yr. Because of loss of renal function, there was no significant increase in total clearance at 1 yr, but this loss of renal clearance was offset by the gain in peritoneal clearance. Residual renal function fell at a similar rate in both the increased dialysis and control groups. In the latter, although peritoneal clearance remained stable over the 1-yr period, loss of renal function resulted in reductions in both total Kt/V and WCC. In conclusion, exchange volume can be increased to compensate for loss of renal function over a 1-yr period. Progressive loss of renal clearance resulted in only a modest gain in total solute clearance. It was the larger patients who tolerated the increase in exchange volumes. However, such patients (by virtue of their size) tended not to achieve target values for solute clearance, and the modest gain in peritoneal clearance was insufficient to increase the number of patients in this group achieving such targets for dialysis adequacy.

Suitable Dialytic Indicators for Pediatric Peritoneal Dialysis Patients: The Alternative to Creatinine Clearance

2003 ◽  
Vol 23 (3) ◽  
pp. 270-275 ◽  
Author(s):  
Kenji Ishikura ◽  
Hiroshi Hataya ◽  
Masahiro Ikeda ◽  
Masataka Honda
Keyword(s):  
Body Weight ◽  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Pediatric Patients ◽  
Stable Condition ◽  
Stepwise Multiple Regression ◽  
Mean Values ◽  
Target Value ◽  
Male Model ◽  
Total Body

← Objective Owing to the discord between body weight and body surface area (BSA), creatinine clearance (CCr) is predisposed to be small in pediatric patients on peritoneal dialysis (PD). Alternatively, Kt/V creatinine (Kt/V creat), which is normalized to total body water (TBW) rather than BSA, could be a better dialytic indicator. In this study, the efficiency of dialysis and the nutritional status of pediatric patients on chronic PD were examined, and the utility of dialytic indicators was evaluated. ← Patients and Methods 49 patients under 20 years old, in stable condition, and on PD were analyzed. Weekly total Kt/V of urea (Kt/V urea), CCr, Kt/V creat, and normalized protein equivalent of nitrogen appearance (nPNA) were measured for all patients and for patients under 6 years old. The target value was 2.0/week for Kt/V urea and 60 L/week/1.73 m2 for CCr, as recommended by the Kidney Disease Outcomes Quality Initiative guidelines. The target value for Kt/V creat was set as 1.52/week, using a male model with a height of 170 cm and a body weight of 65 kg. ← Results The mean values of delivered Kt/V urea, CCr, Kt/V creat, and nPNA (and proportion of patients that achieved each target value) for all patients were 2.25 ± 0.57/week (67.4%), 53.8 ± 19.3 L/week/1.73 2m (26.5%), 1.83 ± 0.73/week (65.3%), and 1.11 ± 0.42 g/day, respectively. The values for patients under 6 years old were 2.38± 0.26/week (90.0%), 45.9 ± 12.8 L/week/1.73 2m (10.0%), 1.94 ± 0.51/week (90.0%), and 1.52 ± 0.67 g/day, respectively. Stepwise multiple regression analyses revealed that the relationship between CCr and Kt/V urea was affected by the patient's age. ← Conclusions Our pediatric patients achieved the recommended target value of Kt/V urea. At the same time, the nPNA results reflected the patient's status well. However, CCr appeared to be inappropriate as an indicator for patients under 6 years old. Kt/V creat is suggested to be a better dialytic indicator for these patients.

The Ratio of Extracellular Fluid to Total Body Water and Technique Survival in Peritoneal Dialysis Patients

2004 ◽  
Vol 24 (4) ◽  
pp. 353-358 ◽  
Author(s):  
Colin H. Jones ◽  
Charles G. Newstead
Keyword(s):  
Peritoneal Dialysis ◽  
Total Body Water ◽  
Extracellular Fluid ◽  
Residual Renal Function ◽  
Body Water ◽  
C Reactive Protein ◽  
Dialysis Patients ◽  
Technique Survival ◽  
Reactive Protein ◽  
Total Body

Background Patients receiving peritoneal dialysis experience a high technique failure rate and are often overhydrated. We examined whether an increased extracellular fluid volume (VECF) as a proportion of the total body water (VTBW) predicted technique survival (TS) in a prevalent patient cohort. Methods The VECF and VTBW were estimated by multiple-frequency bioelectric impedance in 59 prevalent peritoneal dialysis patients (median time on dialysis 14 months). Demographic, biochemical (albumin, C-reactive protein, and ferritin), and anthropometric data, forearm muscle strength, nutritional score by three-point Subjective Global Assessment, residual renal function, dialysate-to-plasma (D/P) creatinine ratio, total weekly Kt/V urea, total creatinine clearance, normalized protein equivalent of nitrogen appearance, and midarm muscle circumference were also assessed. Technique survival was determined at 3 years, and significant predictors of TS were sought. Results In patient groups defined by falling above or below the median value for each parameter, only residual renal function ( p = 0.002), 24-hour ultrafiltrate volume ( p = 0.02), and VECF / VTBW ratio ( p = 0.05) were significant predictors of TS. Subjects with a higher than median VECF / VTBW ratio had a 3-year TS of 46%, compared to 78% in subjects with a lower than median value. In multivariate analysis, systolic blood pressure and VECF / VTBW ratio (both p < 0.05) were significant predictors of TS. C-reactive protein approached significance. Conclusion Increased ratio of extracellular fluid volume to total body water is associated with decreased TS in peritoneal dialysis.

Effects of Amino Acid Dialysis Compared to Dextrose Dialysis in Children on Continuous Cycling Peritoneal Dialysis

1999 ◽  
Vol 19 (3) ◽  
pp. 237-247 ◽  
Author(s):  
Izhar U. Qamar ◽  
Donna Secker ◽  
Leo Levin ◽  
Judith A. Balfe ◽  
Stanley Zlotkin ◽  
...  
Keyword(s):  
Amino Acids ◽  
Peritoneal Dialysis ◽  
Amino Acid ◽  
Creatinine Clearance ◽  
Single Amino Acid ◽  
Fasting Plasma ◽  
Continuous Cycling Peritoneal Dialysis ◽  
Total Plasma Protein ◽  
Continuous Cycling ◽  
Total Body

Objective To compare the biochemical and nutritional effects of amino acid dialysis with dextrose dialysis in children receiving continuous cycling peritoneal dialysis (CCPD). Design A prospective randomized cross-over study. Setting Nonhospitalized patients. Patients Seven children aged 1.8 to 16.0 years (mean 8.1 years) with end-stage renal disease who were receiving CCPD. Interventions Each patient received nighttime automated CCPD of dextrose, plus a single daytime dwell of either amino acid dialysate or dextrose dialysate. After 3 months, subjects crossed over to the alternative regimen for a subsequent 3 months. Main Outcome Measures Creatinine clearance, ultra-filtration, urea, creatinine, electrolytes, total protein, albumin, fasting plasma amino acids, anthropometrics, total body nitrogen. Results Amino acid dialysis was comparable to dextrose dialysis for creatinine clearance and ultrafiltration. Plasma urea concentrations were higher during amino acid dialysis. No clinical side effects or worsening of metabolic acidosis was observed. Caloric intake increased and protein intake improved. Appetite and total body nitrogen increased in at least half the children during amino acid dialysis. Total plasma protein and albumin concentrations did not change significantly. Fasting plasma concentrations of amino acids after 3 months of amino acid dialysis were comparable to baseline values. For several amino acids, the dose-response curve was blunted after a single amino acid exchange following 3 months of amino acid dialysis, which may, in part, be due to the induction of hepatic enzyme synthesis. Conclusions Amino acid dialysis is an efficient form of peritoneal dialysis that should be considered for children with poor nutritional status for whom enteral nutrition supplementation has been unsuccessful. Further study is needed to determine the optimal amount of amino acids to deliver, the best time to administer the amino acid dialysis fluid, and the benefits of adding dextrose to the amino acid solution.

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