Kinetic modelling and underdialysis in CAPD patients

Abstract

Kinetic analysis was performed in all 58 patients undergoing standard CAPD. The urea distribution volume was estimated from anthropomorphic measurements (Watson formulae). Normalized protein catabolic rate (NPCR), daily protein leak (PL), urea and creatinine Kt/Vs, clearances and peritoneal mass transfer coefficients (Kp) were calculated from measurements on serum, 24-h urine and PD fluid effluent. The mean total (renal+PD) daily creatinine and urea Kt/Vs (KT/V) were 0.31 (range 0.15-0.79) and 0.31 (0.18-0.65). There was no relationship between KT/V and serum urea or Kp. The strongest determinant of the urea KT/V was the residual renal urea clearance (KrU)(R = 0.79, P < 0.001) which decreased with time on dialysis (R = -0.38, P < 0.005). There was a significant correlation between the hospital admissions per year and both the urea and creatinine KT/V and KrU (R = -0.30, -0.32, P < 0.05). Patients with urea KT/V < 0.25 (n = 22) had more hospital admissions/year than those with KT/V > 0.25 (mean of 2.6 versus 1.5, P < 0.05). NPCR correlated with urea KT/V (R = 0.62, P < 0.001) but not with serum albumin or the PL. Patients identified by UKM to be less well dialysed have a lower residual renal function and are more likely to be hospitalized. Undernutrition in CAPD patients appears to be related to underdialysis rather than protein loss.

Importance of Residual Renal Function in Continuous Ambulatory Peritoneal Dialysis: Its Influence on Different Parameters of Renal Replacement Treatment

“…According to the literature, nPCR is directly influenced by total dialysis dose and inversely influenced by age [5, 18, 19]. In our study, RRF was the main factor related to nPCR values followed by gender (PCR normalized with distribution volume).…”

“…Therefore, the most important variations in the total dose depend mainly on different degrees of RRF. As a matter of fact, Tattersall et al [5]found a correlation of 0.79 between renal and total KT/V with no significant relationship between total KT/V and the type of peritoneal transport or daily volumes infused. In our study, RRF was the only factor related to total KT/V.…”

“…Although different clinical papers such as the Canada-USA (CANUSA) study [3]showed an inverse relationship between dialysis dose and morbidity and mortality with CAPD, the main changes observed in these studies on the total dialysis dose have been largely dependent on the renal component of dialysis [4, 5]. Therefore, study of the influence of the total dialysis dose on clinical results was in fact assessing the importance of RRF as a prognostic factor.…”

Role of glabridin in maintaining residual kidney function in dialysis patients

“…Some of the drug candidates like irbesartan, spironolactone, and irbesartan plus spironolactone were found to lower peritoneal fibrosis in rats with bacterial peritonitis [6]. Residual renal function (RRF), the measure of dialysis adequacy and creatinine clearance [7] from the kidney accounts for most of the variability in the requirement for dialysis [8]. It is the major determinant of morbidity and mortality in patients on PD [9].…”

Comparative Effects of Carvedilol and Lercanidipine on Ultrafiltration and Solute Transport in CAPD Patients

“…Several factors may contribute to impaired UF, such as the type of buffer used in the dialysate, CAPD of greater than two years duration (even in the absence of peritonitis), increased exposure to dialysate glucose, and possibly diabetes mellitus and the use of b blockers. [5][6][7] b blocker drugs were reported to cause UF failure in CAPD patients. [8] In these patients, hypertension, coronary artery disease, and chronic heart failure are frequently encountered diseases that necessitate b blocker usage.…”