Meta-Analysis

Abstract

Peritoneal membrane solute transport in peritoneal dialysis (PD) patients is assessed by the peritoneal equilibration test, which measures the ratio of creatinine in the dialysate to plasma after a standardized 4-h dwell (D/P c ). Patients then are classified as high, high-average, low-average, or low transporters on the basis of this result. A meta-analysis of observational studies was carried out to characterize the relationship between D/P c and mortality and technique failure in patients who are on PD. Citations were identified in Medline by using a combination of Medical Subject Heading search terms and key words related to PD, peritoneal membrane permeability/transport, and mortality and technique failure. The table of contents of relevant journals and bibliographies of relevant citations were reviewed in duplicate. Twenty studies that met study criteria were identified. Nineteen studies were pooled to generate a summary mortality relative risk of 1.15 for every 0.1 increase in the D/P c (95% confidence interval 1.07 to 1.23; P < 001). This result equated to an increased mortality risk of 21.9, 45.7, and 77.3% in low-average, high-average, and high transporters, respectively, as compared with patients with low transport status. Meta-regression analysis showed that the proportion of patients who were on continuous cycler PD within a study was inversely proportional to the mortality risk (P ‫؍‬ 0.05). The pooled summary relative risk for death-censored technique failure was 1.18 (95% confidence interval 0.96 to 1.46; P ‫؍‬ 0.12) for every 0.1 increase in the D/P c . This meta-analysis demonstrates that a higher peritoneal membrane solute transport rate is associated with a higher mortality risk and a trend to higher technique failure.J Am Soc Nephrol 17: 2591 -2598, 2006 . doi: 10.1681 P atients with ESRD, including those who are on peritoneal dialysis (PD), are at a much higher risk for premature death than the general population. Well-accepted risk factors for early mortality that have been identified in the PD population include age, diabetes, preexisting cardiovascular disease, and malnutrition/hypoalbuminemia (1-6).The peritoneal equilibration test (PET) characterizes the peritoneal membrane transport properties by determining the ratio of the creatinine concentration in the dialysate to that in the plasma after a 4-h dwell (D/P c ) and has been shown to vary considerably among individuals (7). Patients with a greater rate of membrane solute transport (i.e., higher D/P c ) will tend to have enhanced clearance of small solutes, including urea and creatinine, during shorter dwells. However, these patients will have greater peritoneal losses of protein, will be more prone to fluid retention as a result of rapid reabsorption of glucose from the dialysate and subsequent ultrafiltration dysfunction, and will have greater systemic exposure to glucose. These differences may have competing effects on both patient and technique survival such that from a biologic basis, it is unclear what, if any, the effect of pe...

Long-term outcome of chronic dialysis in children

“…Peritoneal membrane function is an independent predictor of patient survival, with those with high transporter status and, therefore, decreased ultrafiltration capacity demonstrating worse outcomes [26]. In a metaanalysis Brimble et al showed an increased mortality risk of 21.9%, 45.7%, and 77.3% in low-average, high-average and high transporters, respectively, compared with patients with low transporter status [27].…”

Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

“…It may be present at the initiation of peritoneal dialysis (PD) but may develop with time on treatment (2,3). Studies of continuous ambulatory PD (CAPD) patients have demonstrated baseline fPTS to be an independent predictor of mortality and technique failure (4). Explanations for this association include reduced peritoneal membrane ultrafiltration capacity owing to more rapid dissipation of the glucose osmotic gradient and resultant fluid reabsorption (5).…”

A Patient on Peritoneal Dialysis with Refractory Volume Overload

“…Patients who are fast transporters have been shown to have evidence of intraperitoneal inflammation (12) and do less well on continuous ambulatory peritoneal dialysis (CAPD) (13). PD prescriptions for this group use APD to deliver shorter dwell times as well as higher dialysate glucose concentrations to avoid reabsorption of fluid.…”