High Peritoneal Transport Status is Not an Independent Risk Factor for High Mortality in Patients Treated with Automated Peritoneal Dialysis

Abstract

We undertook this study to elucidate whether baseline peritoneal membrane transport characteristics are associated with high mortality in incident automated peritoneal dialysis (APD) patients. This retrospective study includes 117 patients who started APD at Yonsei University Health System from 1996 to 2008 and had a PET within 3 months of APD initiation. High transporters were significantly older and had a higher incidence of cardiovascular disease. Patient survival for years 1, 3, and 5 were 85%, 64%, and 35% for high transporter and 94%, 81%, and 68% for non-high transporter group (P<0.01). Multivariate analysis revealed that age, diabetes, cardiovascular disease, serum albumin level, and residual renal function were independently associated with high mortality in APD patients. In contrast, high transport status was not a significant predictor for mortality in this population when the other covariates were included. Even though high transport was significantly associated with mortality in the univariate analysis, its role seemed to be influenced by other comorbid conditions. These findings suggest that the proper management of these comorbid conditions, as well as appropriate ultrafiltration by use of APD and/or icodextrin, must be considered as protective strategies to improve survival in peritoneal dialysis patients with high transport.

Membrane transport status does not predict peritonitis risk in patients on peritoneal dialysis

“…Our study did not find a significant association between higher membrane transport status and poorer outcomes, including survival time on PD until peritonitis, technique failure or death. This is consistent with more recent literature now suggesting that higher peritoneal MTS does not portend a poorer prognosis on PD …”

“…This is consistent with more recent literature now suggesting that higher peritoneal MTS does not portend a poorer prognosis on PD. [23][24][25] The association of age and diabetes mellitus with patient survival on PD is consistent with other studies, 19,20,[26][27][28] suggesting that these factors have clinical significance in predicting prognosis of PD patients. An association between smoking status and peritonitis has been noted in previous literature, 5,9,29,30 which may be because cigarette smoke affects both cell-mediated and humoral-mediated immune responses, thereby increasing risk of infection.…”

Association between Redox Status of Serum Albumin and Peritoneal Membrane Transport Properties in Patients on Peritoneal Dialysis

“…Many studies suggested that high peritoneal transport of protein may lead to malnutrition, inflammation and perhaps morbidity as well as mortality in PD patients [4,5] . However, these findings were not confirmed by more recent studies such as the ADEMEX trial [6][7][8][9][10] and the causes of peritoneal albumin loss and increase mortality have not been completely elucidated. Moreover, when the ultrafiltration problems in these patients were rectified with various measures, in particular, with the wider use of automated peritoneal dialysis (APD), some investigators did not observe the association between peritoneal membrane transport status and the outcome [10] .…”

Peritoneal Equilibration Test and Patient Outcomes

“…However, this premise has never been tested. The inability of some recent studies to show an association between PET parameters and patient outcomes may have been secondary to the use of a potentially insensitive marker of peritoneal ultrafiltration: D/P creatinine (9,(14)(15)(16).…”