A longitudinal, five year survey of urea kinetic parameters in CAPD patients

Abstract

This study reports on the five years' evolution of the KT/V urea index and protein catabolic rate (PCR) in 16 CAPD patients who were treated with a constant daily dialysis dose. Total KT/V urea index decreased with time from a value of 0.96 +/- 0.06 at the start to 0.55 +/- 0.05 at five years of treatment. This decline was due to the opposite changes of two important parameters affecting the index. First, the contribution of the residual urinary KT/V gradually decreased from 28.6% at the start to 8 to 9% after four years. Second, the distribution volume of urea calculated as a constant fraction of body weight gradually increased. The body weight increased from 58.2 +/- 2.79 kg at start to 70.6 +/- 3.33 kg at five years. Peritoneal urea clearances and ultrafiltration rates remained stable. In 12 patients with stable body weight between 24 and 48 months, PCR decreased from 0.98 +/- 0.05 to 0.87 +/- 0.05 g/kg/day. A positive correlation between KT/V urea and PCR and a negative correlation between KT/V urea and number of hospitalization days, peritonitis rates and peripheral nerve conductivity was found. The same negative correlation was found when only the KT/V urea index obtained during the first year of treatment was considered. In conclusion, the KT/V urea index decreases in CAPD patients primarily because residual renal function decreases and body weight increases, while the peritoneal clearing for urea is maintained. The index correlates with some clinical parameters, and may have some prognostic value.

Provision of optimal dialysis for peritoneal dialysis patients

“…Five exchanges/ 19,20 the residual renal function often being negligible after 2 years 16 and zero result in total creatinine clearances greater than 70 L/ at 4 years. 4 There is, however, great variation among most patients with high or high average peritoneal permeability, as indicated in Table 4 (g) and(h). patients in the rate of loss of residual renal function.…”

“…14 Lameire et al, 4,11 patients who have a very small BSA. Moreover, a prescription of 4×2.5 L also results in inadequate total reported negative correlations between Kt/V urea and the number of days of hospitalization, peritonitis rates solute clearance in patients with a large BSA and low or low average peritoneal transport rates.…”

“…Performing a mid-day CAPD mortality rate than those with higher Kt/V. Brandes et al 6 reported significant association between both weekly exchange in addition to standard APD will generate creatinine clearances in excess of 70 L per week in Kt/V and weekly creatinine clearances and clinical outcomes (uremic symptoms, mortality, hospital days, rate [2][3][4][5][6]9,15,16,19,23,24,[26][27][28][29] and between adequacy of dialysis and markers of adequacy of nutrition. 14 nerve conduction 34 and inusing the Watson's formulae, reported an excess of deaths fectious complications.…”

“…The present analysis was therefore undertaken with these recommendations in order to assess the efficiency of In patients receiving chronic peritoneal dialysis, various prescriptions of peritoneal dialysis, to determine mortality, the success of the technique and the number means of maximizing such prescriptions, and thus of days in hospital are directly related to the amount of hopefully to offer dialysis options that would be associated total solute clearance obtained. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] In the CANUSA with improved patient outcomes. study 1 a decrease of 5 L/1.73m 2 creatinine clearance per week was associated with a 7% increase in the relative risk of death.…”

The ADEMEX Study

“…For an anuric 70-kg person, a 12-L drain volume per day would produce a weekly Kt/V of 2.0. Observational studies, using either univariate (3)(4)(5) or multivariate statistical analyses (6,7), suggested that a weekly Kt/V of 1.9 to 2.1 was associated with better patient survival than lower Kt/V values. The Canada-USA (CANUSA) study of incident patients (7) assumed that renal and peritoneal clearances were equivalent and additive with respect to clearance of small solutes.…”