The Impact of Peritoneal Permeability and Residual Renal Function on Pd Prescription

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 147-152 ◽  
Author(s):  
John Harty ◽  
Ram Gokal
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Model Simulation ◽  
High Volume ◽  
Residual Renal Function ◽  
Peritoneal Transport ◽  
Target Values ◽  
Peritoneal Permeability ◽  
The Impact

Our objective was to evaluate the impact of peritoneal transport characteristics and residual renal function on peritoneal clearance and to determine the dialysis volume required to achieve targets for KT/V and weekly creatinine clearance (WCC) in patients with differing weights, renal function, and transport status. Retrospective analysis and mathematical model simulation of urea and creatinine clearance were used. This review demonstrates the important contribution of both residual renal function and peritoneal transport in attaining target values for KT/V and WCC. The limitations of a standard 4 x 2 L dialysis prescription are highlighted in anuric patients and those with low peritoneal transport. In addition, the limitations of short dwell, rapid exchange dialysis modalities are emphasized, especially in patients with low and low average peritoneal transport where daily clearance is demonstrated to be considerably less than conventional continuous ambulatory peritoneal dialysis (CAPD). Attainment of proposed targets for KT/V (1.7) and WCC (50 L) is greatly dependent on residual renal function. In CAPD, peritoneal transport characteristics determine urea clearance through an effect on ultrafiltrate. Thus low transporters of identical weight will have greater values for peritoneal dialysis KT/V. Creatinine clearance is considerably influenced by transport status. The majority of low and low average groups will need some degree of renal function to achieve currently proposed targets. In these patients, conversion to high volume, short dwell modalities will further compromise small solute clearance unless daytime long dwells or tidal dialysis is instigated.

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.

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

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

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

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.

Elimination of Iomeprol in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

1999 ◽  
Vol 19 (4) ◽  
pp. 380-385 ◽  
Author(s):  
Masako Iwamoto ◽  
Kinya Hiroshige ◽  
Takeshi Suda ◽  
Takayuki Ohta ◽  
Akira Ohtani ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Elimination Rate ◽  
Iodine Concentration ◽  
Residual Renal Function ◽  
University Hospitals ◽  
Before And After ◽  
Peritoneal Permeability ◽  
The Mean

Objective To examine the elimination of iomeprol, its safety in clinical use, and its peritoneal permeability in continuous ambulatory peritoneal dialysis (CAPD) patients with variable degrees of residual renal function (RRF). Design A nonrandomized comparison study. Setting Hospitalized patients in CAPD unit of Chikuho and University Hospitals. Participants Fourteen patients treated by CAPD and 6 by hemodialysis (HD). Interventions Total dialysate, blood, and 24-hour urine collections were obtained for 4 consecutive days after the administration of iomeprol. A peritoneal equilibration test was performed just before and after the administration of iomeprol. Measurements Iomeprol (iodine) concentration was measured. Residual renal function was estimated as the mean of renal creatinine and urea clearances. Dialysate-to-plasma ratios (D/P) of creatinine and iomeprol were also determined. Results In all CAPD patients, plasma iomeprol clearance was markedly slow, with a biological half-life ( T1/2) of over 32 hours. However, no patients suffered from any adverse effects, and over 80% of plasma iomeprol was eliminated during the 4-hour HD. The plasma iomeprol elimination rate was significantly higher from 4 hours after the iomeprol administration in CAPD patients with RRF [mean estimated creatinine clearance (CCr) 3.8 mL/min, n = 7] compared to the remaining patients (mean estimated CCr 0.6 mL/min, n = 7); however, T1/2 in patients with RRF was over 24 hours. D/P creatinine was significantly correlated with D/P iomeprol, and peritoneal iomeprol permeability may depend on an individual's peritoneal solute transport properties. Conclusions A prolonged elimination rate of iomeprol was documented in our CAPD patients both with and without RRF. A HD procedure or intensive peritoneal dialysis just after the use of iomeprol may be advisable to promptly remove circulating iomeprol.

Rapid Decline of Residual Renal Function in Patients on Automated Peritoneal Dialysis

1996 ◽  
Vol 16 (3) ◽  
pp. 307-315 ◽  
Author(s):  
Kinya Hiroshige ◽  
Kougi Yuu ◽  
Masasuke Soejima ◽  
Masayuki Takasugi ◽  
Akio Kuroiwa
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Creatinine Clearance ◽  
Experimental Period ◽  
Residual Renal Function ◽  
University Hospital ◽  
Rapid Decline ◽  
Automated Peritoneal Dialysis ◽  
Stage Renal Disease

Objective To determine the effect of peritoneal dialysis modalities such as nightly intermittent peritoneal dialysis (NIPD), continuous cyclic peritoneal dialysis (CCPD), and continuous ambulatory peritoneal dialysis (CAPD) on residual renal function. Design A six-month prospective, nonrandomized comparison study. Setting Outpatient CAPD unit of a university hospital. Participants Eighteen end-stage renal disease patients treated by peritoneal dialysis (8 by NIPD, 5 by CCPD, and 5 by CAPD). Interventions Samples from the total dialysate, blood, and 24hour urine collection were obtained monthly. Measurements Urea, creatinine, and beta2-microglobulin concentrations were measured. Renal and peritoneal clearances of each substance and KT/V urea were calculated. Residual renal function (RRF) was estimated by renal creatinine clearance (RCcr). Results No significant differences in age, sex, and primary renal disease among the three groups were noted. In all groups, anemic and hypertensive states were controlled identically, and mean weekly total (renal + peritoneal) KT/V urea (over 2.1/wk) and total creatinine clearance (over 60 L/wk/1.73 m2) were maintained during the whole experimental period. Starting mean RCcr was near 4.0 mL/min/1.73 m2 in all groups. Thereafter, a rapid and significant decline in RRF was demonstrated on NIPD and CCPD. The declining rates of RCcr values at 6 months after starting NIPD and CCPD were -0.29 and -0.34 mL/min/month, respectively, which were much greater than those of CAPD (+0.01 mL/min/month). Conclusion Because of a possibly characteristic progressive loss of RRF in automated peritoneal dialysis (APD), strict regular assessment of RRF should be performed from the start of APD.

Adequacy Targets Can be Met in Anuric Patients by Automated Peritoneal Dialysis: Baseline Data from Eapos

2001 ◽  
Vol 21 (3_suppl) ◽  
pp. 133-137 ◽  
Author(s):  
Edwina A. Brown ◽  
Simon J. Davies ◽  
Olof Heimbürger ◽  
Frederique Meeus ◽  
George Mellotte ◽  
...  
Keyword(s):  
Renal Function ◽  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Solute Transport ◽  
Clinical Outcomes ◽  
Residual Renal Function ◽  
Baseline Data ◽  
Automated Peritoneal Dialysis ◽  
Treatment Optimization ◽  
Dialysis Outcomes

♦ Objective Conventional continuous ambulatory peritoneal dialysis (CAPD) in patients without residual renal function and with high solute transport is associated with worse clinical outcomes. Automated peritoneal dialysis (APD) has the potential to improve both solute clearance and ultrafiltration in these circumstances, but its efficacy as a treatment modality is unknown. The European Automated Peritoneal Dialysis Outcomes Study (EAPOS) is a 2-year, prospective, European multi-center study designed to determine APD feasibility and clinical outcomes in anuric patients. The present article describes the baseline data for patients recruited into the study. ♦ Design All PD patients treated in the participating centers were screened for inclusion criteria [urinary output < 100 mL/24 h, or residual renal function (RRF) < 1 mL/min, or both]. After enrollment, changes were made to the dialysis prescription to achieve a weekly creatinine clearance above 60 L per 1.73 m2 and an ultrafiltration rate above 750 mL in 24 hours. ♦ Setting The study is being conducted in 26 dialysis centers in 13 European countries. ♦ Baseline Data Collection The information collected includes patient demographics, dialysis prescription, achieved weekly creatinine clearance, and 24-hour ultra-filtration (UF). ♦ Results The study enrolled 177 anuric patients. Median dialysis duration before enrollment was 22.5 months (range: 0 – 285 months). Mean solute transport measured as the dialysate-to-plasma ratio of creatinine (D/PCr) was 0.74 ± 0.12. Patients received APD for a median of 9.0 hours overnight (range: 7 – 12 hours) using a median of 11.0 L of fluid (range: 6 – 28.75 L). Median daytime volume was 4.0 L (range: 0.0 – 9.0 L). Tidal dialysis was used in 26 patients, and icodextrin in 86 patients. At baseline, before treatment optimization, the weekly mean total creatinine clearance was 65.2 ± 14.4 L/1.73 m2, with 105 patients (60%) achieving the target of more than 60 L/1.73 m2. At baseline, 81% of patients with high transport, 69% with high-average transport, and 40% with low-average transport met the target. At baseline, 70% of patients with a body surface area (BSA) below 1.7 m2, 60% with a BSA of 1.7 – 2.0 m2, and 56% with a BSA above 2.0 m2 achieved 60 L/1.73 m2 weekly. Median UF was 1090 mL/24 h, and 75% of patients achieved the UF target of more than 750 mL/24 h. ♦ Conclusion This baseline analysis of anuric patients recruited into the EAPOS study demonstrates that a high proportion of anuric patients on APD can achieve dialysis and ultrafiltration targets using a variety of regimes. This 2-year follow-up study aims to optimize APD prescription to reach predefined clearance and ultrafiltration targets, and to observe the resulting clinical outcomes.

High Peritoneal Permeability is Not Associated with Higher Mortality or Technique Failure in Patients on Automated Peritoneal Dialysis

2008 ◽  
Vol 28 (1) ◽  
pp. 82-92 ◽  
Author(s):  
Xiao Yang ◽  
Wei Fang ◽  
Joanne M. Bargman ◽  
Dimitrios G. Oreopoulos
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Survival ◽  
High Body Mass Index ◽  
Technique Survival ◽  
Peritoneal Transport ◽  
Significant Independent Risk Factor ◽  
Observational Cohort ◽  
Peritoneal Permeability ◽  
The Impact ◽  
Technique Failure

Background Patients on continuous ambulatory peritoneal dialysis (CAPD) who have high small-molecule peritoneal transport have increased mortality. Objective To investigate the impact of baseline peritoneal transport characteristics on patient and technique survival in incident peritoneal dialysis (PD) patients, most of whom are on automated PD (APD), with the use of icodextrin. Design Retrospective observational cohort study. Setting A single PD unit. Patients and Methods 193 new patients that began PD between January 2000 and September 2004, and had an initial peritoneal equilibration test within 6 months of commencement of PD. Patients were divided into low (L), low average (LA), high average (HA), and high (H) peritoneal transport groups. Death-censored technique failure and patient survival were examined. Results Of the 193 patients, 151 (78.1%) were on APD or on APD with icodextrin or on CAPD with icodextrin. At the end of 1, 3, and 5 years, patient survival was 91%, 82%, and 67% in LA group; 95%, 77%, and 69% in HA group; and 96%, 71%, and 71% in H group. Technique survival was 100%, 90%, and 77% in LA group; 96%, 84%, and 72% in HA group; and 92%, 87%, and 77% in H group. High peritoneal permeability did not predict worse patient survival or technique failure, while age, diabetes, a lower glomerular filtration rate, and high body mass index (≥ 30 kg/m2) were independent predictors of death. Conclusion This study suggests that higher peritoneal transport is not a significant independent risk factor for either mortality or death-censored technique failure. The favorable outcome for high transporters in this study may be due to improved management of volume status by the increased use of APD and the use of icodextrin-based dialysis fluid.

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