Adequacy of Continuous Ambulatory Peritoneal Dialysis: Morbidity and Mortality in Chronic Peritoneal Dialysis

Teehan, Brendan P.; Schleifer, Charles R.; Brown, Joan M.

doi:10.1016/s0272-6386(12)81074-2

Cited by 49 publications

(14 citation statements)

References 20 publications

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“…Borrowing terminology from epidemiology (21), this likely reflects a “detection bias” phenomenon that, in the context of the current investigation, would involve changes in the rate of event detection (rather than rate occurrence, per se ) over calendar time. As a result of increased research and discussion with respect to PD adequacy in the late 1980s and early 1990s (22-26), nephrologists might have been more likely to identify CAPD patients as being inadequately dialyzed, due to heightened awareness. As emphasized by Teehan et al (24) and Hakim (26), analyses of the National Cooperative Dialysis Study (27-29) reveal that gross underdialysis of HD patients went unrecognized by the onsite investigators.…”

Section: Discussionmentioning

confidence: 99%

Trends in CAPD Technique Failure: Canada, 1981–1997

2001

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Objective Although important enhancements to continuous ambulatory peritoneal dialysis (CAPD) have occurred since its inception, few studies have explicitly evaluated trends over time in CAPD technique failure rates. To assist in quantifying the net benefit of improvements to CAPD for patient outcomes, we examined trends in technique failure rates among Canadian CAPD patients. Patients Patients initiating renal replacement therapy on CAPD ( n = 7110) between 1981 and 1997. Main Outcome Measures Technique failure ( i.e., switch to hemodialysis). Results Total follow-up was 12 831 patient-years (pt-yr). There were 1976 technique failures, for a crude CAPD failure rate of 154.0/1000 pt-yr. Technique failure rate ratios (RR) estimated using Poisson regression and adjusted for age, gender, race, province, primary renal diagnosis, and follow-up time, were significantly reduced for the 1990–93 [RR = 0.75, 95% confidence interval (CI) = (0.68, 0.83)], 1994–95 [RR = 0.83, CI (0.75, 0.93)], and 1996–97 [RR = 0.78, CI (0.70, 0.87)] calendar periods relative to 1981–89 (RR = 1, reference). Among cause-specific technique failure rates, the greatest improvement was observed for peritonitis-attributable technique failure, with RR = 0.46, CI (0.41, 0.50) for 1990–97 relative to 1981–89. However, rates of technique failure due to inadequate dialysis were significantly elevated for the 1990–97 period [RR = 1.68, CI (1.44, 1.96)]. Conclusions The collection of more detailed data on practice patterns would enable future studies to elucidate the cause-and-effect relationship between CAPD descriptors and technique failure, and hence assist in clinical decision-making.

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Section: Discussionmentioning

confidence: 99%

Trends in CAPD Technique Failure: Canada, 1981–1997

2001

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“…This might explain why ADEMEX failed to find a difference in outcome between patients with and without adequate dialysis according to the DOQI guidelines (31). A variety of other single‐center experiences did not show increases in mortality until delivered Kt / V was less than 1.9 (32), 1.85 (18), 1.7 (33), or 1.5 (34). Many nephrologists remain convinced that the adequacy targets posed by DOQI are too high, and that “adequate dialysis” is present as long as Kt / V urea is greater than 1.7/week, unless other clinical or biochemical signs of inadequate dialysis are present (35).…”

Section: Solute Removal In Anuric Patientsmentioning

confidence: 89%

Peritoneal Dialysis in Anuric Patients: Concerns and Cautions

Biesen

Vanholder

Veys

et al. 2002

Seminars in Dialysis

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Most recent studies have found an equivalent survival for patients on peritoneal dialysis (PD) and hemodialysis (HD); evidence even suggests that PD might be the preferred modality during the first 3-4 years of renal replacement therapy. This is probably related to the continuous and minimally invasive character of PD as compared to HD, resulting in better preservation of residual renal function (RRF) and less cardiovascular strain. On the other hand, blood pressure control, fluid balance, and adequacy targets may be difficult to obtain in long-term PD patients. The question arises whether PD is a feasible option in anuric patients. It is clear that the answer depends on the body size and the peritoneal membrane transport characteristics of the patient, so that PD will be feasible in some anuric patients, whereas in others it will not be. Evaluation of the peritoneal transport characteristics and adaptation of the PD prescription is warranted. A constant evaluation of the fluid balance, nutritional, and cardiovascular status is needed. This article reviews the physiologic insights and clinical evidence necessary for a good PD prescription in anuric patients.

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“…A similar situation might exist for PD. Peritoneal dialysis dose appears to be an important independent correlate of morbidity and mortality until wKt/V exceeds some nominal value (1.7, 1.96, 2.0, or 2.1) (7,28,33,69), at which time nCAR and body size may become more valuable indicators of morbidity and mortality risk (24,70).…”

Section: Discussionmentioning

confidence: 99%

Nutritional Markers during Peritoneal Dialysis: Data from the 1998 Peritoneal Dialysis Core Indicators Study

et al. 2001

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Objective This analysis explores the nutritional status of adult U.S. peritoneal dialysis (PD) patients. Design The Peritoneal Dialysis Core Indicators Study is a prospective cross-sectional prevalence survey describing the care provided to a random sample of adult U.S. PD patients. Methods and Population Prevalence data were collected from a national random sample of 1381 adult PD patients participating in the United States End Stage Renal Disease (ESRD) program. Results The median age of these patients was 55 years, 61% were Caucasian; the leading cause of ESRD was diabetes mellitus. Age, sex, size, peritoneal permeability, dialysis adequacy, and nutritional indices did not differ between patients on continuous ambulatory PD and patients on automated PD. The dialysis prescriptions employed achieved mean weekly Kt/V urea (wKt/V) and creatinine clearance (wCCr) values of 2.22 ± 0.57 and 67.8 ± 22.5 L/1.73 m2/week, respectively. The PD patients were large, with a mean body weight of 77 ± 21 kg and body mass index (BMI) of 27 ± 8.6 kg/m2. The mean serum albumin of these patients was 3.5 ± 0.51 g/dL, and 43% of values fell below the National Kidney Foundation Dialysis Outcomes Quality Initiative's desired range. The PD patients had a normalized protein equivalent of nitrogen appearance (nPNA) of 1.0 ± 0.57 g/kg/day, a normalized creatinine appearance rate (nCAR) of 17 ± 7.3 mg/kg/day, and an estimated lean body mass (%LBM) of 62% ± 18% of body weight. Serum albumin correlated positively with patient size, nCAR, and nPNA, but negatively with age, the presence of diabetes mellitus, female gender, erythropoietin dose, the creatinine dialysate-to-plasma ratio results of peritoneal equilibration testing, and the dialysis portion of the wCCr. The duration of ESRD experience correlated negatively with both serum albumin and patient size, although these relationships were complex. Conclusion Peritoneal dialysis patients generally have marginal serum albumin levels, a finding incongruent with alternative measures of nutritional status, such as weight, BMI, and creatinine generation. Serum albumin is reduced in patients with high peritoneal permeability ( i.e., rapid transporters) and, because these patients generally have higher than average wCCr values, serum albumin is inversely correlated with the dialysis component of the wCCr. The presumptive nutritional indicators (BMI, %LBM, nPNA, and serum albumin) provide disparate estimates, varying from 10% to 50% for the prevalence of nutritionally stressed PD patients.

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Adequacy of Continuous Ambulatory Peritoneal Dialysis: Morbidity and Mortality in Chronic Peritoneal Dialysis

Cited by 49 publications

References 20 publications

Trends in CAPD Technique Failure: Canada, 1981–1997

Trends in CAPD Technique Failure: Canada, 1981–1997

Peritoneal Dialysis in Anuric Patients: Concerns and Cautions

Nutritional Markers during Peritoneal Dialysis: Data from the 1998 Peritoneal Dialysis Core Indicators Study

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