Randomized prospective study of the effect of increased dialytic dose on nutritional and clinical outcome in continuous ambulatory peritoneal dialysis patients

Mak, Siu‐Ka; Wong, Ping‐Nam; Lo, Kin‐Yee; Tong, Gensy M.W.; Fung, Lewis H.; Wong, Andrew K.

doi:10.1053/ajkd.2000.8278

Cited by 43 publications

(31 citation statements)

References 23 publications

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“…The ADEMEX study recently reported that increasing dialysis dosing failed to improve outcome parameters [19]. Starting at lower dialysis prescription levels, increasing dialysis dose resulted in improved patient outcome in anuric adults, including nPCR and peritonitis rate [18]. These data suggest that PD adequacy close to the DOQI criteria represents a threshold in adult PD, above which no further improvement in patient outcome occurs.…”

Section: Discussionmentioning

confidence: 98%

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Risk factors for peritonitis in pediatric peritoneal dialysis: a single-center study

et al. 2005

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Recent US registry data and a European multicenter study described increased risk of peritonitis in young children on peritoneal dialysis (PD). No underlying age-specific risk factors could be defined in these reports. Therefore, we analyzed risk factors for peritonitis in children treated by PD as primary renal replacement therapy at the Kinderdialyse, Vienna, and particularly searched for age-specific aspects. Thirty children (15 boys, mean age 4.6 years) received PD [21 automated peritoneal dialysis (APD), nine continuous ambulatory peritoneal dialysis (CAPD)] for 13 months (3-49 months). During the total observation period of 395 dialysis months, 27 peritonitis episodes were diagnosed (1:14.6 months or 0.82/patient per year). Of our population, 43% remained peritonitis free; seven patients suffered from more than one peritonitis episode. Ten potential risk factors [age, gender, PD modality, duration of PD, exit-site status, urine volume, residual glomerular filtration rate (GFR), Kt/V, normalized protein catabolic rate (nPCR), albumin] and four indices of peritonitis outcome (peritonitis incidence, peritonitis burden, risk of suffering more than one episode of peritonitis and chance of staying free from peritonitis) were analyzed. Our study identified six risk factors in univariate analysis, namely age, APD treatment, exit-site infections, low urinary volume, low residual GFR and low nPCR, which were significantly correlated with two or more of the outcome indices. Multivariate analysis identified exit-site infection and residual urine volume as strong independent predictors. In summary, our study identified several age-dependent and age-independent risk factors for peritonitis in pediatric PD. These data demonstrate that the risk for peritonitis in small children is not pre-determined but might be open to therapeutic interventions, such as optimizing exit-site care, dialysis prescription and nutrition management.

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Section: Discussionmentioning

confidence: 98%

“…In adults on chronic PD, however, data on effects of increasing PD adequacy are inconclusive [18,19]. The ADEMEX study recently reported that increasing dialysis dosing failed to improve outcome parameters [19].…”

Section: Discussionmentioning

confidence: 99%

Risk factors for peritonitis in pediatric peritoneal dialysis: a single-center study

et al. 2005

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“…It appears that correction of metabolic acidosis improves the nutritional status of Asian PD patients, which is consistent with the results from earlier reports in Western PD patients. Reported data indicate that dietary protein and energy intakes are not much different, although actual dietary intake of nutrients is independently influenced by the delivered dialysis dose and RRF in Asian PD patients (26). The effect of peritoneal membrane transport characteristics on long-term nutritional status remains controversial (27).Establishing a relationship between dialysis adequacy and nutritional status (and clinical outcome) would give nutrition a central role and thus have important therapeutic implications.…”

Section: Global Perspectivementioning

confidence: 99%

Nutritional Considerations in Indian Patients on PD

Nayak¹,

Nayak²,

Prabhu³

et al. 2011

Progress in Peritoneal Dialysis

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“…Several studies of PD patients have examined the effect of a decline in RRF on quality of life including development of uremic symptoms and also on mortality [1][2][3][4]. Other studies have looked at the improvement in the clearances of biochemical parameters, nutritional status and mortality after an increase in the dialysis dose [5][6][7]. However, not many studies have examined the effect of increasing the dose of dialysis on uremic symptoms which might develop during the course of PD.…”

Section: Introductionmentioning

confidence: 99%

Improvement in uremic symptoms after increasing daily dialysate volume in patients on chronic peritoneal dialysis with declining renal function

et al. 2004

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Randomized prospective study of the effect of increased dialytic dose on nutritional and clinical outcome in continuous ambulatory peritoneal dialysis patients

Cited by 43 publications

References 23 publications

Risk factors for peritonitis in pediatric peritoneal dialysis: a single-center study

Risk factors for peritonitis in pediatric peritoneal dialysis: a single-center study

Nutritional Considerations in Indian Patients on PD

Improvement in uremic symptoms after increasing daily dialysate volume in patients on chronic peritoneal dialysis with declining renal function

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