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

Abstract

♦ 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.

Mitigating peritoneal membrane characteristics in modern peritoneal dialysis therapy

“…There was a high penetration of icodextrin use (45%) in EAPOS; patients using it at the start of the study had worse membrane function as determined by higher solute transport and less good ultrafiltration capacity and yet they achieved as good daily ultrafiltration as those not on icodextrin. 28,51,60,61 Furthermore, in these patients there was no detectable adverse effect of solute transport on achieved daily ultrafiltration, whereas for the remaining patients high transport was negatively correlated despite the use of APD. Icodextrin did not have an independent beneficial effect on survival in EAPOS but it clearly had an additional beneficial effect and was of value to patients with worse membrane function.…”

Renal Association Clinical Practice Guideline on peritoneal dialysis in adults and children

“…The vast majority of PD patients will be able to reach these clearance targets, especially if APD is employed [ 72 ]. These guidelines must however be viewed as recommendations for minimal overall clearance.…”

Significant Decreasing Incidence of Encapsulating Peritoneal Sclerosis in the Dutch Population of Peritoneal Dialysis Patients

“…"Adequacy" and "problems with maintaining euvolemia" as reasons for dropout increase over time, especially as residual renal function declines. Nevertheless, even anuric patients can be maintained successfully on PD (2). Many patients are reluctant to transfer to HD, even when clinically indicated, because they perceive that such a transfer would adversely affect their quality of life.…”