Higher Peritoneal Transport Status Is Associated with Higher Mortality and Technique Failure in the Australian and New Zealand Peritoneal Dialysis Patient Populations

Abstract

Although early studies observed that peritoneal membrane transport characteristics were determinants of morbidity and mortality in peritoneal dialysis (PD) patients, more recent investigations, such as the Ademex trial, have refuted these findings. The aim of this study was to determine whether baseline peritoneal transport status predicted subsequent survival in Australian and New Zealand PD patients. The study included all adult patients in Australia and New Zealand who commenced PD between April 1, 1999, and March 31, 2004, and had a peritoneal equilibration test (PET) performed within 6 mo of PD commencement. Times to death and death-censored technique failure were examined by Kaplan-Meier analyses and multivariate Cox proportional hazards models. PET measurements were available in 3702 (72%) of the 5170 individuals who began PD treatment in Australia or New Zealand during the study period. In these patients, high transporter status was found to be a significant, independent predictor of death-censored technique failure (adjusted hazard ratio [AHR] 1.23; 95% confidence interval [CI] 1.02 to 1.49; P ‫؍‬ 0.03) and mortality (AHR 1.34; 95% CI 1.05 to 1.79, P ‫؍‬ 0.02) compared with low-average transport status. High-average transport class was also associated with mortality (AHR 1.21; 95% CI 1.00 to 1.48; P ‫؍‬ 0.047) but not death-censored technique failure (AHR 1.04; 95% CI 0.90 to 1.21) compared with low-average transport status. When transport status was alternatively analyzed as a continuous variable, dialysate:plasma creatinine ratio at 4 h was independently predictive of both death-censored technique failure (AHR 1.07; 95% CI 1.01 to 1.295; P ‫؍‬ 0.031) and death (AHR 1.09; 95% CI 1.01 to 1.373; P ‫؍‬ 0.036 per 0.1 change in dialysate:plasma creatinine). Peritoneal transport rate is a highly significant risk factor for both mortality and death-censored technique failure in the Australian and New Zealand incident PD patient populations.

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

“…In a large study of 3702 incident PD patients, a high transporter status was an independent predictor of technique failure and mortality (adjusted HR 1.23, 95% CI 1.02 to 1.49, P ϭ 0.03 and adjusted HR 1.34, 95% CI 1.05 to 1.79, P ϭ 0.02, respectively) (46). This observation has been confirmed by several other studies (47)(48)(49).…”

Long-term outcome of chronic dialysis in children

“…However, the recent NAPRTCS data have shown that the time to the first episode of peritonitis is longer in children with two cuff catheters, swan-neck tunnels and for downward pointing exit sites [2]. 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 Albumin and Protein Losses Do Not Predict Outcome in Peritoneal Dialysis Patients

“…Subsequently, fast transport status has been associated with hypoalbuminaemia (10), high comorbidity status (11), mortality, and technique failure (12,13). However, it should be emphasized that the latest data cast doubt on these associations (14)(15)(16).…”