Adequacy of peritoneal dialysis

Burkart, John M.

doi:10.1007/978-94-017-3225-3_14

Cited by 17 publications

(17 citation statements)

References 124 publications

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“…The serum creatinine level is valid and a clinically useful marker of protein-energy nutritional status in maintenance dialysis patients. The serum creatinine level reflecting the nutritional status is inversely related to mortality in patients with PD (26)(27)(28)(29)(30)(31). In our study, patients with higher creatinine levels at the beginning of treatment and during the follow-up period had higher survival rates similar to the results of Sipahioglu et al's (10) and Ates et al's (22) studies from Turkey.…”

Section: Dıscussıonsupporting

confidence: 87%

Clinical Outcomes of Peritoneal Dialysis Patients at a Secondary State Hospital Nephrology Clinic

Sarı¹,

Sarıkaya²,

Çetinkaya³

et al. 2012

Turk Neph Dial Transpl

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OBJECTIVE: We present our experience with demographics, clinical and biochemical outcomes, and factors affecting mortality in ESRD patients treated with peritoneal dialysis (PD) during a 12-year period (1997–2009) at secondary state hospital's nephrology clinic.MATERIAL and METHODS: After excluding patients younger than age 15 at the initiation of PD, those who had follow-ups at less than three months, outcomes were analyzed for 313 patients. The demographic, clinical, and biochemical data were collected from the patients' medical records.RESULTS: The mean age at the start of PD was 51.9 ± 17.6 years and the mean PD duration was 27.5 ± 27.1 months (median: 20, range: 3–166). Hypertension was the most common cause of ESRD (36.1%), followed by diabetes mellitus (31.3%). Among these 313 patients, 58 (18.5%) died. Patients' survival rates were 93.3%, 85%, and 72.4%, at one, three, and five years, respectively. A higher educational level (p=0.045), lower age (p=0.002), higher baseline creatinine (p=0.045), and higher baseline albumin level (p=0.003) were found to affect patients' survival. Technique survival rates were 89.1%, 84%, and 74.1% at one, three and five years, respectively. Technique failure was associated with peritonitis rate (p=0.03).CONCLUSION: Our results suggest that patients' and technique survival rates and the factors affecting mortality in our patients at a secondary state hospital's nephrology clinic were similar to those at a tertiary care university hospital's nephrology clinic in Turkey

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Section: Dıscussıonsupporting

confidence: 87%

Clinical Outcomes of Peritoneal Dialysis Patients at a Secondary State Hospital Nephrology Clinic

Sarı¹,

Sarıkaya²,

Çetinkaya³

et al. 2012

Turk Neph Dial Transpl

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“…These observations support the notion that differences in peritonitis rates do not explain the differences in peritoneal protein losses. The permeability of the peritoneal membrane to macromolecules can be assessed by measuring the concentration of total proteins in the dialysate and comparing it with the concentration of total proteins in the plasma [dialysate (total protein) /plasma (total protein) ] or D/P ratio [26]. Higher permeability of the peritoneal membrane to protein results in higher dialysate protein concentrations and, therefore, a higher D/P ratio.…”

Section: Discussionmentioning

confidence: 99%

Peritoneal protein losses in children with steroid-resistant nephrotic syndrome on continuous-cycler peritoneal dialysis

2006

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Glomerular protein permeability rises in nephrotic syndrome and may result from the effect of an unidentified "circulating factor." The effect of this "circulating factor" on the permeability of other body membranes is unknown. In this study we examine the peritoneal membrane protein permeability in patients with nephrotic syndrome on chronic-cycler peritoneal dialysis. We conducted a retrospective study of peritoneal protein losses in the dialysate effluent of 60 pediatric peritoneal dialysis patients (ages 5.1-22 years) over a 6-year period (January 1997-December 2002). Nineteen patients had steroid-resistant nephrotic syndrome (SRNS), while 41 had other non-nephrotic etiologies of renal failure. Total and normalized peritoneal protein losses are higher in SRNS than in non-nephrotic patients (12,603+/-5,403 mg/day vs 4,475+/-469 mg/day, P<0.05; 297.8+/-79.3 mg/kg per day vs 156.8+/-16.0 mg/kg per day, P<0.05; 9,614.6+/-3,253.4 mg/m(2) per day vs 4,168.3+/-367.3 mg/m(2) per day, P<0.05). The ratio of total protein in dialysate to plasma, a measure of peritoneal membrane protein permeability, was higher in SRNS patients (3.50+/-1.00% vs 0.68+/-0.06%, P<0.001). Serum albumin concentration was lower in SRNS patients (3.09+/-0.13 mg/dl vs 3.52+/-0.07 mg/dl, P<0.01). There were no differences between the two groups with regard to duration of peritoneal dialysis, dialysis prescription, numbers of peritonitis episodes, catheter replacements, or hospitalizations. In summary, these results demonstrate that peritoneal protein losses in patients with SRNS are twice as great as in those without nephrotic syndrome. These results are consistent with the systemic effect of a "circulating factor" in SRNS and underscore the importance of adequate protein intake in patients on peritoneal dialysis.

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“…Overall small solute clearance is most closely related to uremic toxicity; small solute clearance in terms of urea or creatinine kinetics should be used for monitoring dialysis adequacy (36). In our study, multivariate analysis revealed that, among the dialysis adequacy estimates, only total Kt/V urea independently predicted mortality.…”

Section: Discussionmentioning

confidence: 99%

Patient and Technique Survival and Factors Affecting Mortality on Peritoneal Dialysis in Turkey: 12 Years’ Experience in a Single Center

et al. 2008

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Background We investigated patient and technique survival and factors affecting mortality in Turkish peritoneal dialysis (PD) patients. Patients and Methods This was a retrospective study. 423 PD patients were included. The demographic, clinical, and biochemical data were collected from the medical records. Clinical outcomes were mortality and technique failure. Results Mean age at the start of PD was 46.0 ± 14.3 years and mean PD duration was 37.1 ± 28.3 (median: 30, range: 4 – 137) months. Diabetes mellitus was the most common cause of end-stage renal disease (35.2%), followed by hypertension (14.7%). There were 89 (21.0%) deaths. 25 (5.9%) patients received a kidney transplant, 74 (17.4%) patients were transferred to hemodialysis. Estimation of technique survival by Kaplan–Meier was 96.1%, 83.2%, 67.6%, 45.8%, and 33.6% at 1, 3, 5, 8, and 10 years. Technique failure was associated with peritonitis rate [relative risk (RR): 3.22, p < 0.001] and peritoneal Kt/V urea (RR: 0.38, p = 0.001) in the Cox proportional hazards model analysis. Estimation of patient survival by Kaplan–Meier was 96.9%, 83.8%, 68.8%, 50.2%, and 40.7% at 1, 3, 5, 8, and 10 years, respectively. In the Cox proportional hazards model analysis, age (RR: 1.01, p = 0.05), transfer to PD from hemodialysis (RR: 1.84, p = 0.03), comorbid cardiovascular disease (RR: 1.90, p = 0.004), serum creatinine level (RR: 0.75, p < 0.001), total Kt/V urea (RR: 0.34, p < 0.001), peritonitis rate (RR: 1.87, p < 0.001), and dialysate-to-plasma creatinine ratio (RR: 6.49, p = 0.04) predicted mortality. Conclusions Even though we cannot conclude with certainty that survival rates in Turkish patients are better than those in the United States and Europe, our results seem to suggest this and warrant further studies adjusted for more extensive demographic features and comorbidities. The factors affecting mortality in Turkish PD patients are similar to other populations.

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Adequacy of peritoneal dialysis

Cited by 17 publications

References 124 publications

Clinical Outcomes of Peritoneal Dialysis Patients at a Secondary State Hospital Nephrology Clinic

Clinical Outcomes of Peritoneal Dialysis Patients at a Secondary State Hospital Nephrology Clinic

Peritoneal protein losses in children with steroid-resistant nephrotic syndrome on continuous-cycler peritoneal dialysis

Patient and Technique Survival and Factors Affecting Mortality on Peritoneal Dialysis in Turkey: 12 Years’ Experience in a Single Center

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