Predicted and Measured Daily Creatinine Production in CAPD: Identifying Noncompliance

1995 ◽  
Vol 15 (1) ◽  
pp. 22-25 ◽  
Author(s):  
Karl D. Nolph ◽  
Zbylut J. Twardowski ◽  
Ramesh Khanna ◽  
Harold L. Moore ◽  
Barbara F. Prowant
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Lean Body Mass ◽  
Body Mass ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Albumin Concentration ◽  
Serum Albumin Concentration ◽  
Cross Sectional ◽  
Male Patients ◽  
Sectional Analysis

Objective To evaluate the ratio of measured creatinine (Cr) production to predicted creatinine production as an index of noncompliance in patients on continuous ambulatory peritoneal dialysis (CAPD). Design A cross-sectional analysis. Patients One hundred and twenty-one patients on CAPD. Measurements We have calculated Cr production from measured Cr outputs in 24-hour collections of urine and dialysate. Predicted Cr productions were calculated from standard tables. Weekly KTN urea and weekly Cr clearances were determined from the same 24-hour urine and dialysate collections. Lean body mass (LBM) was calculated from the Cr production. Serum albumin concentration was measured. Results The ratio of measured/predicted Cr production correlated positively and significantly with weekly KTN urea, the protein equivalent of nitrogen appearance (PNA), weekly Cr clearance, and LBM. There was a decline in serum albumin concentration at ratios greater than 1.24, supporting the opinions of previous authors who have suggested that ratios greater than 1.24 are highly suggestive of noncompliance with the dialysis prescription. Defining noncompliance as a ratio greater than 1.24 implied that at least 5% of the female and 17% of the male patients were noncompliant. Conclusions Declining serum albumin concentrations at higher ratios of measured/predicted Cr production support the opinion that this is an index of noncompliance. However, not all noncompliant patients necessarily have a ratio greater than 1.24. Weekly KTN urea, weekly Ccr and LBM are all artifactually increased by “washout effects” if all exchanges are done only or mainly on the collection day.

Cross Sectional Assessment of Weekly Urea and Creatinine Clearances and Indices of Nutrition in Continuous Ambulatory Peritoneal Dialysis Patients

1993 ◽  
Vol 13 (3) ◽  
pp. 178-183 ◽  
Author(s):  
Karl D. Nolph ◽  
Harold L. Moore ◽  
Barbara Prowant ◽  
Marianne Meyer ◽  
Zbylut J. Twardowski ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Nutritional Status ◽  
Serum Albumin ◽  
Lean Body Mass ◽  
Body Mass ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Cross Sectional ◽  
Sectional Analysis ◽  
Net Protein ◽  
Small Solute

Objective To perform a cross sectional analysis in 71 patients on continuous ambulatory peritoneal dialysis (CAPD) to identify significant correlations of weekly small solute clearances and indices of nutritional status with each other and with patient demographics and other commonly monitored clinical and laboratory parameters. Design This was a retrospective, cross sectional analysis in 71 patients on CAPD from less than 1 to 105 patient-months (average, 20 months). Setting An outpatient CAPD program. Patients All patients on CAPD in our program at the time of the study willing to undergo the clearance and nutritional status measurements. Interventions No interventions other than the monitoring of their status. Main Outcome Measures Weekly small solute clearances, dietary protein intake, serum albumin, lean body mass, net protein catabolic rate, and urinary and dialysate nitrogen. Results Weekly K/V urea (weekly urea clearance normalized to total body water) of at least 1.7 and weekly total creatinine clearances (liter/week/1.7 m2) of at least 50 are associated with net protein catabolic rates (PCR) greater than 0.9 g/kg of normalized body weight in average CAPD patients. K/V urea and net PCR correlate significantly with serum albumin. High transporters identified by the peritoneal equilibration test have greater albumin losses and lower serum albumin concentrations. Estimates of lean body mass correlate significantly with serum albumin and net PCR; lean body mass correlates significantly and inversely with age. Conclusions Greater small solute clearances are associated with better nutritional status.

scholarly journals Predominant Factors Affecting Sexual Dysfunction on Patients with Continuous Ambulatory Peritoneal Dialysis

2021 ◽  
Vol 9 (B) ◽  
pp. 373-377
Author(s):  
Yuswinda Kusumawardhani ◽  
Krisna Yetti ◽  
I Made Kariasa
Keyword(s):  
Peritoneal Dialysis ◽  
Sexual Dysfunction ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Sampling Technique ◽  
Dominant Factor ◽  
Cross Sectional ◽  
Plasma Urea ◽  
Factors Affecting ◽  
Male Patients ◽  
Sectional Analysis

BACKGROUND: Sexual dysfunction is a complication of terminal kidney failure. The problem of fulfilling sexual needs of men undergoing Continuous Ambulatory Peritoneal Dialysis (CAPD) is influenced by many factors. AIM: This study aims to find out the most dominant factor affecting the sexual dysfunction of men who undergo CAPD. METHODS: The design of this study was cross-sectional analysis with a sample of 70 men CAPD patients using a purposive sampling technique from February to May 2020. Data collection was carried out offline and online by filling in the questionnaire sheets for respondent characteristics, International Index of Erectile Function, and looking at laboratory result. RESULTS: The results showed there was a correlation between age (p=0.0024), plasma urea (p=0.018), and albumin (p=0.001) with sexual dysfunction in male patients using CAPD. There was no significant correlation between length of time undergoing CAPD (p=0.678), fasting glucose (0.051), triglycerides (p=0.536), and cholesterol (p=0.183) with sexual dysfunction in male patients who undergo CAPD. The most dominant factor affecting is albumin, where patients who have albumin levels < 3.5 g/dL are at risk of experiencing sexual dysfunction 9.3 times greater than patients with albumin levels 3.5-5 g/dL after being controlled by age variables. CONCLUSION: The recommendation of this study is protein intake of 1.2-1.5 g/kg body weight with at least 60% of protein with high biological value and evaluation of the ability of care and replacement of CAPD at home.

A Risk Analysis of Continuous Ambulatory Peritoneal Dialysis-Related Peritonitis

2005 ◽  
Vol 25 (4) ◽  
pp. 374-379 ◽  
Author(s):  
Kai Ming Chow ◽  
Cheuk Chun Szeto ◽  
Chi Bon Leung ◽  
Bonnie Ching-Ha Kwan ◽  
Man Ching Law ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Confidence Interval ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Hazard Ratio ◽  
Albumin Concentration ◽  
Serum Albumin Concentration ◽  
Increased Risk

Objective We studied the clinical characteristics that influence the risk of dialysis-related peritonitis complication in incident Chinese patients undergoing continuous ambulatory peritoneal dialysis (CAPD). Methods A single center, retrospective, observational cohort study was carried out to examine the risk factors of developing a first episode of dialysis-related peritonitis. Results Between 1995 and 2004, 246 incident CAPD patients were recruited for analysis. During the study period of 897.1 patient-years, 85 initial episodes of peritonitis were recorded. The median peritonitis-free time for diabetic subjects was significantly worse than for nondiabetic subjects (49.0 ± 10.5 vs 82.3 ± 12.6 months, p = 0.0019). The difference was due mainly to a higher likelihood of developing peritonitis with gram-negative organisms in patients with diabetes mellitus ( p = 0.038). Low serum albumin concentration was also associated with worse peritonitis-free survival. There was a nonsignificant trend toward an increased risk for peritonitis in the group of patients with cerebrovascular disease. According to multivariate Cox proportional hazards model for the analysis of time to first peritonitis episode, the two independent risk factors were presence of diabetes mellitus and initial serum albumin concentration. In particular, diabetes mellitus was associated with a hazard ratio of 1.50 and a 95% confidence interval of 1.05 – 2.40 ( p = 0.030) to develop an initial peritonitis. Lower serum albumin level at the start of CAPD was a significant predictor of peritonitis, with hazard ratio of 1.67 for every decrease of 10 g/L, and 95% confidence interval 1.08 – 2.60 ( p = 0.021). Conclusions Our results confirm the susceptibility of diabetic CAPD and hypoalbuminemic patients to peritonitis, and highlight the role of further studies in reducing this complication.

The Role of Lean Body Mass as a Nutritional Index in Chinese Peritoneal Dialysis Patients—Comparison of Creatinine Kinetics Method and Anthropometric Method

2000 ◽  
Vol 20 (6) ◽  
pp. 708-714 ◽  
Author(s):  
Cheuk-Chun Szeto ◽  
Johnathan Kong ◽  
Alan K.L. Wu ◽  
Teresa Y.H. Wong ◽  
Angela Y.M. Wang ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Lean Body Mass ◽  
Body Mass ◽  
Chinese Patients ◽  
Nutritional Indices ◽  
Protein Nitrogen ◽  
Creatinine Kinetics ◽  
The Mean ◽  
The Difference

Objective To compare, in Chinese continuous ambulatory peritoneal dialysis (CAPD) patients, the creatinine kinetics method (LBM-CK) and the anthropometric method (LBM-AM) for determining lean body mass (LBM). Design Single-center cross-sectional study. Patients and Methods We studied 151 unselected CAPD patients (78 males, 73 females). We calculated LBM-CK and LBM-AM using standard formulas. The results of the two methods were then compared by the Bland and Altman method. Dialysis adequacy and other nutritional indices, including total Kt/V, weekly creatinine clearance (CCr), residual glomerular filtration rate (GFR), protein nitrogen appearance (PNA), subjective global assessment (SGA), and serum albumin, were measured simultaneously. Results The mean age of the patients was 55.6 ± 12.2 years, and the mean duration of dialysis was 33.6 ± 28.5 months. The mean body mass index (BMI) was 22.7 ± 3.7. The average LBM-AM was 43.6 ± 8.0 kg; the average LBM-CK was 33.0 ± 9.3 kg. The difference between the calculated LBM-AM and LBM-CK was 10.7 kg, with LBM-AM always giving a higher value; the limits of agreement were –5.8 kg and 27.1 kg. The difference between the two measures correlated with residual GFR (Pearson r = 0.629, p < 0.001). After normalizing for desired body weight, LBM-AM was only modestly correlated with serum albumin level. No correlations were found between overall SGA score or normalized protein nitrogen appearance (nPNA) and LBM-AM or LBM-CK. Conclusions In Chinese patients at least, a substantial discrepancy exists between LBM-AM and LBM-CK. The difference is especially marked in patients with significant residual renal function. The optimal method for determining LBM remains obscure in Chinese CAPD patients. Moreover, LBM correlated poorly with other nutritional indices. Multiple parameters should be taken into consideration in an assessment of nutritional status of CAPD patients.

scholarly journals Association between Serum Albumin Concentration and Ketosis Risk in Hospitalized Individuals with Type 2 Diabetes Mellitus

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Po-Chung Cheng ◽  
Shang-Ren Hsu ◽  
Yun-Chung Cheng
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Serum Albumin ◽  
Medical Center ◽  
Albumin Concentration ◽  
Cerebrovascular Event ◽  
Serum Albumin Concentration ◽  
Cross Sectional

Objective.This study examined the association between serum albumin concentration and ketosis risk in hospitalized individuals with type 2 diabetes mellitus (T2DM).Methods. A retrospective cross-sectional study was conducted at a medical center in Taiwan. Inclusion criteria were endocrinology ward inpatients exceeding 21 years of age, with preexisting diagnosis of T2DM, and blood glucose above 13.9 millimoles per liter (mmol/L) at admission. Individuals without measurement of serum albumin, urine ketone, or hemoglobin A1C, or harboring active infection, myocardial infarction, cerebrovascular event, cirrhosis, malignancy, or overt proteinuria were excluded. Using serum albumin concentration below 3.0 grams per deciliter to define hypoalbuminemia, 151 hypoalbuminemic cases and 104 normoalbuminemic controls were enrolled. The presence of ketones in urine established ketosis.Results. The prevalence of ketonuria was 48% in hypoalbuminemic subjects compared to 30% in normoalbuminemic controls (odds ratio (OR): 2.15; 95% confidence interval (CI): 1.26–3.57;P=0.004). Moreover, among the 156 subjects with serum beta-hydroxybutyrate measurement in addition to urine ketone, 33% of the hypoalbuminemic individuals had ketonemia exceeding 3 mmol/L compared to 19% of those with normoalbuminemia (OR: 2.12, 95% CI: 0.99–4.48,P=0.051).Conclusions. Serum albumin concentration is inversely associated with ketosis risk in hospitalized individuals with T2DM.

An Elevated Ratio of Measured to Predicted Creatinine Production in Capd Patients is Not a Sensitive Predictor of Noncompliance with the Dialysis Prescription

1996 ◽  
Vol 16 (2) ◽  
pp. 142-146 ◽  
Author(s):  
John M. Burkart ◽  
Anthony J. Bleyer ◽  
Jean R. Jordan ◽  
Nancy C. Zeigler
Keyword(s):  
Peritoneal Dialysis ◽  
Prospective Study ◽  
Creatinine Clearance ◽  
Lean Body Mass ◽  
Body Mass ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Study Design ◽  
Recent Period

Objective To determine the effect a period of “intentional noncompliance” in stable continuous ambulatory peritoneal dialysis (CAPD) patients has on the ratio of measured to predicted creatinine generation. Design Prospective study that compares baseline to noncompliant periods in individual CAPD patients. Patients Nine chronic, stable CAPD patients. Study Design At baseline, measured creatinine production and adequacy parameters (KT/V, creatinine clearance, lean body mass, and protein equivalent of nitrogen appearance) were calculated from 24-hour collections of dialysate and urine while patients were performing their routine dialysis prescriptions. After three days of intentional noncompliance (one less exchange/day) the patients repeated their 24-hour collections, again performing their routine number of exchanges. Measured creatinine production and adequacy parameters were again calculated. Predicted creatinine production for each patient was calculated from standard equations. All parameters at baseline were compared to corresponding parameters after intentional noncompliance. Results In all patients, except one where there was no change, there was a statistically significant increase in not only the ratio of measured to predicted creatinine production but also all other parameters. Conclusion As suspected by previous investigators, this study suggests that one cause of an elevated ratio of measured to predicted creatinine production may be a recent period of noncompliance with the patient's dialysis prescription. However, these data suggest that an isolated ratio of measured to predicted creatinine generation is not a sensitive predictor of noncompliance with the peritoneal dialysis prescription.

Urea Kinetics and Clinical Features of Long Term Continuous Ambulatory Peritoneal Dialysis Patients

1993 ◽  
Vol 13 (2_suppl) ◽  
pp. 180-182 ◽  
Author(s):  
Kazuo Kumano ◽  
Yutaka Takagi ◽  
Shinji Yokota ◽  
Satoru Shimura ◽  
Tadasu Sakai
Keyword(s):  
Peritoneal Dialysis ◽  
Serum Albumin ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Clinical Assessment ◽  
Biochemical Parameters ◽  
Clinical Symptoms ◽  
Close Correlation ◽  
Albumin Concentration ◽  
Assessment Scores ◽  
Urea Kinetics

The purpose of this study was to assess urea kinetic modeling (UKM) as a marker for adequate dialysis in continuous ambulatory peritoneal dialysis (CAPD) patients. UKM was conducted on 19 anuric patients on CAPD for more than 2 years. Serum β2-microglobulin (β2M) was also measured as a marker of large molecular weight substances. Patient clinical conditions were evaluated by the doctors and patients as well. The patients were thus asked to complete a questionnaire on uremic symptoms an d daily activities. A comparison was made in urea kinetics and biochemical parameters based on clinical assessment scores. Patient and doctor scores showed a close correlation (r=0.69) and were correlated to days of hospitalization. The peritonitis rate was significantly higher in the “not doing well” group. No correlation could be found between indexes of UKM or β2M plasma level and clinical assessment scores. A signlficant correlation was noted between serum albumin concentration and doctor scores (r=0.52). It was thus concluded that UKM was not a good indicator of the adequacy of dialysis for CAPD, but serum albumin was. However, clinical symptoms and signs are more important than biochemical parameters for assessing adequacy.

Resting Energy Expenditure in Peritoneal Dialysis Patients

2006 ◽  
Vol 26 (6) ◽  
pp. 697-704 ◽  
Author(s):  
Ana P. Bazanelli ◽  
Maria A. Kamimura ◽  
Camila Barbosa da Silva ◽  
Carla M. Avesani ◽  
Miriam G. Garcia Lopes ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Energy Expenditure ◽  
Lean Body Mass ◽  
Body Mass ◽  
Body Fat ◽  
Resting Energy Expenditure ◽  
Healthy Individuals ◽  
Female Patients ◽  
Male Patients ◽  
And Gender

Objectives This study aimed to evaluate whether resting energy expenditure (REE) of patients undergoing peritoneal dialysis (PD) therapy differs from that of healthy individuals, as well as to investigate the factors associated with REE in this sample of patients. Design Cross-sectional study. Setting Dialysis Unit of the Nephrology Division, Federal University of Sao Paulo–Oswaldo Ramos Foundation, Brazil. Subjects and Methods The study examined the REE of 37 patients (20 males, age 44.5 ± 13 years) undergoing PD therapy. Only patients older than 18 years, on PD for at least 3 months, without catabolic illness, and with normal thyroid function were included. Patients were pair matched for age and gender with 37 healthy individuals. REE was measured by indirect calorimetry. Body composition was assessed by dual-energy x-ray absorptiometry in the patients and by bioelectrical impedance in the healthy individuals. Results The REE of PD patients was similar to that of pair-matched controls (1372 ± 266 and 1453 ± 252 kcal/day respectively, p = 0.13) even when adjusted for lean body mass and gender ( p = 0.56). The REE of PD patients was positively correlated with lean body mass ( r = 0.60, p < 0.01), fat mass ( r = 0.43, p < 0.01), body mass index (r = 0.60, p < 0.01), serum glucose (r = 0.36, p < 0.05), and protein equivalent of nitrogen appearance (PNA; r = 0.42, p < 0.01). There were no correlations between REE and glucose absorption, dialysis-related parameters, C-reactive protein, and energy or protein intake by 3-day food diary. In the multiple linear regression analysis, using REE as the dependent variable, the final model showed that lean body mass and female gender were determinants of REE in PD patients ( R2 = 0.44). When separate analysis by gender was performed, REE correlated directly with body fat in female patients (r = 0.70, p < 0.01) but not in male patients ( r = 0.29, p = 0.21). On the other hand, lean body mass was significantly correlated with REE in male patients ( r = 0.78, p < 0.01) but not in female patients ( r = 0.47, p = 0.06). Conclusions This study showed that REE of PD patients did not differ from that of healthy individuals. The strong association between body fat and REE in female patients remains to be further investigated.

Clinical factors affecting cerebral oxygenation in patients undergoing peritoneal dialysis

2021 ◽  
pp. 039139882110200
Author(s):  
Taisuke Kitano ◽  
Kiyonori Ito ◽  
Susumu Ookawara ◽  
Taro Hoshino ◽  
Hideyuki Hayasaka ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Peritoneal Dialysis ◽  
Linear Regression ◽  
Serum Albumin ◽  
Cerebral Oxygenation ◽  
Linear Regression Analysis ◽  
Albumin Concentration ◽  
Healthy Controls ◽  
Serum Albumin Concentration ◽  
Factors Affecting

Background: Although cerebral regional oxygen saturation (rSO2) is significantly lower in hemodialysis (HD) patients than that in healthy controls, investigations on cerebral oxygenation in peritoneal dialysis (PD) patients are limited. We aimed to confirm the cerebral oxygenation status and identify the factors affecting cerebral rSO2 in PD patients. Methods: Thirty-six PD patients (21 men and 15 women; mean age, 62.8 ± 12.7 years) were recruited. In addition, 27 healthy volunteers (17 men and 10 women; mean age, 43.5 ± 18.8 years) were recruited as a control group. Cerebral rSO2 was monitored at the forehead using an INVOS 5100c oxygen saturation monitor. Results: Cerebral rSO2 was significantly lower in PD patients than that in healthy controls (57.0 ± 7.3% vs 68.9 ± 8.6%, p < 0.001); moreover, cerebral rSO2 was significantly correlated with natural logarithm (Ln)-PD duration ( r = −0.389, p = 0.019) and serum albumin concentration ( r = 0.370, p = 0.026) in a simple linear regression analysis. Multivariable linear regression analysis was performed using variables that showed a significant correlation and p < 0.20 (serum creatinine, serum sodium, Ln-C-reactive protein, and dosage of erythropoiesis-stimulating agent) with the cerebral rSO2. Cerebral rSO2 was independently associated with Ln-PD duration (standardized coefficient: −0.339) and serum albumin concentration (standardized coefficient: 0.316). Conclusions: Cerebral rSO2 was significantly affected by the PD duration and serum albumin concentration. Further prospective studies are needed to clarify whether preventing a decrease in serum albumin concentration leads to the maintenance of cerebral oxygenation in patients undergoing PD.

Sign in / Sign up

Export Citation Format

Share Document