Continuous Peritoneal Dialysis in Heavyweight Individuals: Urea and Creatinine Clearances

Tzamaloukas, Antonios H.; Dimitriadis, Athanasios; Murata, Glen H.; Nicolopoulou, N; Malhotra, Deepak; Balaskas, Elias V.; Kakavas, J; Antoniou, Stavros A.; Dombros, Nicholas V.; E, Batzili; Voudiklari, S

doi:10.1177/089686089601600312

Cited by 25 publications

(18 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Poorer solute clearance might also explain the greater risk of infection-associated catheter loss in the obese patients reported by Piraino and co-workers (17). Peritoneal dialysis affords less-efficient small solute clearance than hemodialysis and may be particularly limiting in large patients (18–20). Moreover, loss of RRF, which is strongly correlated with PD peritonitis (21), has recently been found to occur at a more rapid rate in obese individuals than in normal or underweight PD patients (22).…”

Section: Discussionmentioning

confidence: 99%

Obesity is a Risk Factor for Peritonitis in the Australian and New Zealand Peritoneal Dialysis Patient Populations

et al. 2004

View full text Add to dashboard Cite

Objective The aim of the present investigation was to examine the association between body mass index (BMI) and peritonitis rates among incident peritoneal dialysis (PD) patients in a large cohort with long-term follow-up. Design Retrospective observational cohort study of the Australian and New Zealand PD patient population. Setting Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Participants The study included all incident adult patients ( n = 10 709) who received PD in Australia and New Zealand in the 12-year period between 1 April 1991 and 31 March 2003. Patients were classified as obese (BMI ≥ 30 kg/m2), overweight (BMI 25.0 – 29.9 kg/m2), normal weight (20 – 24.9 kg/m2), or underweight (< 20 kg/m2). Main Measurements Time to first peritonitis and episodes of peritonitis per patient-year were recorded over the 12-year period. Results Higher BMI was associated with a shorter time to first peritonitis episode, independent of other risk factors [hazard ratio 1.08 for each 5-kg/m2 increase in BMI, 95% confidence interval (CI) 1.04 – 1.12, p < 0.001]. When peritonitis outcomes were analyzed as episodes of peritonitis per patient-year, these rates were significantly higher among patients with higher BMI: underweight 0.69 episodes/year (95% CI 0.66 – 0.73), normal weight 0.79 (95% CI 0.77 – 0.81), overweight 0.88 (95% CI 0.85 – 0.90), obese 1.06 (95% CI 1.02 – 1.09). Coronary artery disease and chronic lung disease were associated with both shorter time to first peritonitis and higher peritonitis rates, independently of these other factors. There was also a “vintage effect,” with lower peritonitis rates seen among people who commenced dialysis in more recent years. Conclusions Higher BMI at the commencement of renal replacement therapy is a significant risk factor for peritonitis. The mechanisms for this remain undefined.

show abstract

Section: Discussionmentioning

confidence: 99%

Obesity is a Risk Factor for Peritonitis in the Australian and New Zealand Peritoneal Dialysis Patient Populations

et al. 2004

View full text Add to dashboard Cite

show abstract

“…Unfortunately, these clearances are below those suggested by K/DOQI. Tzamaloukas et al reported that, in order to achieve adequate clearances (defined in this paper as weekly Kt/V of 1.7 and CC of 54.4 L/1.73 m 2 ) in heavyweight individuals, high 24-hour volumes of over 20 L were necessary, with a combination of nocturnal APD plus daily CAPD (14). The use of nocturnal APD and daytime CAPD was reported as being a “tolerable inconvenience,” although the true impact on the quality of life of in these patients over a long period of time was not reported.…”

Section: Discussionmentioning

confidence: 97%

“…Of these patients, only 58.7% achieved both total Kt/V and CC within established K/DOQI guidelines; 14.4% of the patients had acceptable Kt/V but low CC, 11.5% had acceptable CC but low Kt/V, and 15.4% had low Kt/V and low CC (8). Maintaining acceptable clearances as residual renal function declines has generally been reported to be difficult, particularly in patients with large body mass (14) or L or LA transport characteristics (2).…”

Section: Discussionmentioning

confidence: 99%

Increasing the Dialysis Volume and Frequency in a Fixed Period of Time in CPD Patients: The Effect on Kpt/V and Creatinine Clearance

et al. 2002

View full text Add to dashboard Cite

Background The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) has evidence- and opinion-based recommendations for weekly Kt/Vurea and weekly total creatinine clearance (CC) in chronic peritoneal dialysis (CPD) patients. Using standard continuous ambulatory peritoneal dialysis technique, it is often difficult to achieve the suggested targets in anuric patients with large body mass. Thus, the use of automated peritoneal dialysis (APD) has been increasingly utilized to achieve adequate clearances. Automated dialysis is usually performed at night over an 8- to 10-hour period. The role of increases in dialysate volume and frequency of exchanges during this time period to achieve these target K/DOQI recommendations remains uncertain. We decided to study the effects of increasing the volume and number of exchanges in a fixed period of time in CPD patients. Methods In the New Haven CAPD unit, 29 patients maintained on APD were considered eligible for the study and 11 agreed to participate. The patients were characterized according to standard peritoneal equilibration test criteria. The patients were placed into two groups: group 1 included high (H) and high-average (HA), and group 2 low-average (LA) transporters. The patients were dialyzed at night for 9 hours with standard cycling technique, using 2.5% Dianeal (Baxter Healthcare, Deerfield, Illinois, USA) solution, with a cycle volume of 2500 mL, and a 2000-mL daytime dwell. Three studies were done on each patient using a total dialysis volume of 9.5 L (3 cycles), 14.5 L (5 cycles), and 19.5 L (7 cycles). Daily Kpt/Vurea and daily CCp (peritoneal) (L/day/1.73 m2) were obtained. Results Six patients were H or HA (group 1) and 5 were LA transporters (group 2). For the group 1 patients, mean weight was 86.6 ± 13.5 kg; Kpt/Vurea was 1.68 ± 0.21 using 9.5 L, 2.03 ± 0.28 for 14.5 L ( p < 0.05 compared to 10 L), and 2.28 ± 0.28 with 19.5 L ( p < 0.05 compared to 10 L and 15 L); mean weekly CCp was 45.43 ± 7.63 L/1.73 m2 for 9.5 L ( p < 0.05 compared to 14.5 L and 19.5 L), 51.17 ± 7.07 with 14.5 L, and 54.67 ± 10.08 for 19.5 L; ultrafiltration rates were not different in the three studies. For the group 2 patients, mean weight was 74.3 ± 17.7 kg; mean weekly Kpt/Vurea was 1.68 ± 0.35 using 9.5 L, 2.10 ± 0.42 for 14.5 L ( p < 0.05 compared to 9.5 L), and 2.31 ± 0.56 for 19.5 L ( p < 0.05 compared to 9.5 L and 14.5 L); mean weekly CCp was 42.56 ± 10.64 L/1.73 m2 for 9.5 L ( p < 0.05 compared to 14.5 L and 19.5 L), 50.89 ± 12.66 for 14.5 L, and 51.94 ± 11.20 for 19.5 L; ultrafiltration was lower in the 9.5-L study than in the 14.5-L and 19.5-L studies, but was not different in the 14.5-L and 19.5-L studies. Conclusions In both H/HA and LA transporters, Kpt/Vurea and CCp rise significantly when the frequency of exchanges and total volume of dialysate are increased. Thus, the use of larger volumes of dialysate with cycling peritoneal dialysis may result in increased clearances of urea and creatinine.

show abstract

“…The use of additional daytime exchange is required in such patients. A benefit of improving daily QOL disappears, although one report indicates that a combination of daily CAPD plus nocturnal APD with a large dialysate volume in patients weighing 100 kg or more resulted in the same acceptable clearance levels as those in lean CAPD patients (11). We demonstrated that lower transporters initially treated by NIPD or CCPD could be dialyzed with a total Kt/V urea over 2.1 and total creatinine clearance over 60 L/week for at least an initial 6 months because of their significant diuresis (12).…”

Section: Disadvantagesmentioning

confidence: 99%

Clinical Benefits and Problems in Recent Automated Peritoneal Dialysis Treatment

1998

View full text Add to dashboard Cite

Continuous Peritoneal Dialysis in Heavyweight Individuals: Urea and Creatinine Clearances

Cited by 25 publications

References 6 publications

Obesity is a Risk Factor for Peritonitis in the Australian and New Zealand Peritoneal Dialysis Patient Populations

Obesity is a Risk Factor for Peritonitis in the Australian and New Zealand Peritoneal Dialysis Patient Populations

Increasing the Dialysis Volume and Frequency in a Fixed Period of Time in CPD Patients: The Effect on Kpt/V and Creatinine Clearance

Clinical Benefits and Problems in Recent Automated Peritoneal Dialysis Treatment

Contact Info

Product

Resources

About