Adequacy of Peritoneal Dialysis-Where Are We Going?

Poor compliance in peritoneal dialysis (PD) is a significant cause of dropout and morbidity. PD Adequest software, which, through a mathematical model, predicts the effect of the dialysis prescription on the basis of the peritoneal transport, may be used to identify the noncompliant patient. Fifty patients from two dialysis centers, aged 65.9±1.5 years and on PD for 28.6±4.7 months, were studied. A peritoneal equilibration test (PET) was carried out and 24hour urine and dialysate were collected. Total weekly creatinine clearance (CrCI, L/week/1.73 m2) was calculated, as well as the glomerular filtration rate [(GFR), mL/min, mean CrCI and urea nitrogen clearance (UNCI)]. The dialytic schedules used were then introduced into the program and the parameters were recalculated using the software model. Nine patients considered noncompliant from their case histories were used to assess the differences of reference between expected and measured values. The control group was significantly different from the noncompliant group in the percentage of the CrCI and the serum creatinine (sCR) differences. The noncompliance threshold value was calculated from the mean of the lower 95% confidence interval of the compliant group and the higher one of the noncompliant group (-5.3%) for CrCI and vice versa for sCR (+10%), which behaved to the contrary. Reassessing the patients, 11 (22%) were identified as probably noncompliant.

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1996 Peritoneal Dialysis Core Indicators Study: Report on Nutritional Indicators

Flanigan

Bailie

Frankenfield

et al. 1998

Perit Dial Int

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Objective The 1996 Peritoneal Dialysis Core Indicators Study illustrates the conduct of peritoneal dialysis in the United States during 1996. Design and Patient Population The survey is a medical records audit of 1317 randomly selected adult U.S.A. Medicare patients using peritoneal dialysis during 1996. Outcome Measures Abstracted data included basic demographic characteristics, dialysis prescription, delivered dialysis dose, residual renal function, serum albumin, hematocrit, anemia management, and patient status. Results The survey included 785 patients using continuous ambulatory peritoneal dialysis (CAPD) and 423 using automated peritoneal dialysis (APD) primarily in the form of continuous cycling peritoneal dialysis (CCPD). Except for the prescription mechanics and a greater likelihood that African-Americans would use CAPD, the groups did not differ substantially from one another. Evaluation of patient weight (W), body mass index (BMI), residual renal function, average serum albumin, protein equivalent of nitrogen appearance (nPNA), and dialysis efficiency as weekly fractional urea nitrogen removal (wKt/V urea) and weekly creatinine clearance (wCrCI) revealed a picture of reasonable dialysis delivery and marginal protein nutrition. Additionally, there was little evidence that “dialysis efficiency,” over the range assessed, had a major influence on nutritional status. Despite a tendency toward obesity (body weight = 76.6 ± 20.0 kg and BMI = 27 ± 7), 47% of patients had an average serum albumin below “normal” (3.5 g/dL by bromcresol green) and 70% had a nPNA below 1.0 g/kg/day. Conclusions Peritoneal dialysis patients appear to have marginal protein reserves despite surfeit energy stores.

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Adequacy of Peritoneal Dialysis-Where Are We Going?

Cited by 4 publications

References 24 publications

The Importance of Monitoring Dialysis Adequacy in Chronic Peritoneal Dialysis

The Importance of Monitoring Dialysis Adequacy in Chronic Peritoneal Dialysis

Compliance Study in Peritoneal Dialysis Using Pdadequest Software

1996 Peritoneal Dialysis Core Indicators Study: Report on Nutritional Indicators

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