Peritoneal Transport Status Correlates With Morbidity But Not Longitudinal Change of Nutritional Status of Continuous Ambulatory Peritoneal Dialysis Patients: A 2-Year Prospective Study

Szeto, Cheuk‐Chun; Law, Man-Ching; Wong, Teresa Yuk‐Hwa; Leung, Chi-Bon; Li, Philip Kam-Tao

doi:10.1053/ajkd.2001.21298

Cited by 58 publications

(41 citation statements)

References 24 publications

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“…If no evident cause of the inflammation is found, then use of more biocompatible PD solutions (22,23) or a transfer to hemodialysis to rest the peritoneal membrane should be considered. In patients with inflammation, use of icodextrin and of short cycles is also warranted to avoid overhydration, which might be an important additional cause of the inflammation and the increased mortality in these patients (5,6,9,24,25).…”

Section: Discussionmentioning

confidence: 99%

The Personal Dialysis Capacity Test Is Superior to the Peritoneal Equilibration Test to Discriminate Inflammation as the Cause of Fast Transport Status in Peritoneal Dialysis Patients

Biesen¹,

Tol²,

Veys³

et al. 2006

Clinical Journal of the American Society of Nephrology

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Section: Discussionmentioning

confidence: 99%

The Personal Dialysis Capacity Test Is Superior to the Peritoneal Equilibration Test to Discriminate Inflammation as the Cause of Fast Transport Status in Peritoneal Dialysis Patients

Biesen¹,

Tol²,

Veys³

et al. 2006

Clinical Journal of the American Society of Nephrology

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“…Data were abstracted directly from studies that analyzed PET results in their model using the continuous variable, D/P c (8 -14); authors from two additional studies provided these data upon request (5,11). A number of studies (5,(15)(16)(17)(18)(19)(20)(21)(22)(23) categorized subjects according to their D/P c as described previously (7). In this classification, subjects are defined as high (H) transporters when their 4-h D/P c was more than 1 SD above the median value, highaverage (HA) when between the median and 1 SD above, low-average (LA) when between the median and 1 SD below, and low (L) when below 1 SD (in the original publication, mean and SD D/P c were 0.65 and 0.15, respectively).…”

Section: Statistical Analysesmentioning

confidence: 99%

“…Only four studies clearly indicated that deaths that occurred after transfer to HD were counted events (5,8,10,16). Heterogeneity testing permitted pooling of the studies to generate a summary risk estimate (Q statistic ϭ 16.95, P ϭ 0.…”

Section: Mortality Outcomementioning

confidence: 99%

“…Many studies censored for death, an adverse competing event that may provide a misleading estimate of the event risk when using standard Kaplan-Meier methods (44). Therefore, analyses were carried out summarizing separately studies that provided information on death-censored technique failure (transfer to HD) (5,8,11,14,16,23) and those that analyzed transfer to HD or death as an outcome (5,16,40). One study did indicate that peritoneal transport status did not influence technique failure; however, no data were provided or could be obtained, and, therefore, the study was not included in this analysis (33).…”

Section: Technique Failurementioning

confidence: 99%

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Meta-Analysis

Brimble¹,

Walker²,

Margetts³

et al. 2006

Journal of the American Society of Nephrology

236

202

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Peritoneal membrane solute transport in peritoneal dialysis (PD) patients is assessed by the peritoneal equilibration test, which measures the ratio of creatinine in the dialysate to plasma after a standardized 4-h dwell (D/P c ). Patients then are classified as high, high-average, low-average, or low transporters on the basis of this result. A meta-analysis of observational studies was carried out to characterize the relationship between D/P c and mortality and technique failure in patients who are on PD. Citations were identified in Medline by using a combination of Medical Subject Heading search terms and key words related to PD, peritoneal membrane permeability/transport, and mortality and technique failure. The table of contents of relevant journals and bibliographies of relevant citations were reviewed in duplicate. Twenty studies that met study criteria were identified. Nineteen studies were pooled to generate a summary mortality relative risk of 1.15 for every 0.1 increase in the D/P c (95% confidence interval 1.07 to 1.23; P < 001). This result equated to an increased mortality risk of 21.9, 45.7, and 77.3% in low-average, high-average, and high transporters, respectively, as compared with patients with low transport status. Meta-regression analysis showed that the proportion of patients who were on continuous cycler PD within a study was inversely proportional to the mortality risk (P ‫؍‬ 0.05). The pooled summary relative risk for death-censored technique failure was 1.18 (95% confidence interval 0.96 to 1.46; P ‫؍‬ 0.12) for every 0.1 increase in the D/P c . This meta-analysis demonstrates that a higher peritoneal membrane solute transport rate is associated with a higher mortality risk and a trend to higher technique failure.J Am Soc Nephrol 17: 2591 -2598, 2006 . doi: 10.1681 P atients with ESRD, including those who are on peritoneal dialysis (PD), are at a much higher risk for premature death than the general population. Well-accepted risk factors for early mortality that have been identified in the PD population include age, diabetes, preexisting cardiovascular disease, and malnutrition/hypoalbuminemia (1-6).The peritoneal equilibration test (PET) characterizes the peritoneal membrane transport properties by determining the ratio of the creatinine concentration in the dialysate to that in the plasma after a 4-h dwell (D/P c ) and has been shown to vary considerably among individuals (7). Patients with a greater rate of membrane solute transport (i.e., higher D/P c ) will tend to have enhanced clearance of small solutes, including urea and creatinine, during shorter dwells. However, these patients will have greater peritoneal losses of protein, will be more prone to fluid retention as a result of rapid reabsorption of glucose from the dialysate and subsequent ultrafiltration dysfunction, and will have greater systemic exposure to glucose. These differences may have competing effects on both patient and technique survival such that from a biologic basis, it is unclear what, if any, the effect of pe...

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“…Although the superiority of D/P creatinine over D/D0 glucose or UFV for risk prediction has never been established, it is the parameter used almost exclusively for these purposes (5)(6)(7)(8)(9)(10). The utility of PET in optimizing PD prescription is primarily related to prediction of daily ultrafiltration; however, D/P creatinine is only modestly related to UFV (11,12).…”

Section: Introductionmentioning

confidence: 99%

Peritoneal Equilibration Test and Patient Outcomes

Mehrotra

Ravel

Streja

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Although a peritoneal equilibration test yields data on three parameters (4-hour dialysate/plasma creatinine, 4-to 0-hour dialysate glucose, and 4-hour ultrafiltration volume), all studies have focused on the prognostic value of dialysate/plasma creatinine for patients undergoing peritoneal dialysis. Because dialysate 4-to 0-hour glucose and ultrafiltration volume may be superior in predicting daily ultrafiltration, the likely mechanism for the association of peritoneal equilibration test results with outcomes, we hypothesized that they are superior to dialysate/plasma creatinine for risk prediction.Design, setting, participants, & measurements We examined unadjusted and adjusted associations of three peritoneal equilibration test parameters with all-cause mortality, technique failure, and hospitalization rate in 10,142 patients on peritoneal dialysis treated between January 1, 2007 and December 31, 2011 in 764 dialysis facilities operated by a single large dialysis organization in the United States, with a median follow-up period of 15.8 months; 87% were treated with automated peritoneal dialysis.Results Demographic and clinical parameters explained only 8% of the variability in dialysate/plasma creatinine. There was a linear association between dialysate/plasma creatinine and mortality (adjusted hazards ratio per 0.1 unit higher, 1.07; 95% confidence interval, 1.02 to 1.13) and hospitalization rate (adjusted incidence rate ratio per 0.1 unit higher, 1.05; 95% confidence interval, 1.03 to 1.06). Dialysate/plasma creatinine and dialysate glucose were highly correlated (r=20.84) and yielded similar risk prediction. Ultrafiltration volume was inversely related with hospitalization rate but not with all-cause mortality. None of the parameters were associated with technique failure. Adding 4-to 0-hour dialysate glucose, ultrafiltration volume, or both did not result in any improvement in risk prediction with dialysate/plasma creatinine alone.Conclusions This analysis from a large contemporary cohort treated primarily with automated peritoneal dialysis validates dialysate/plasma creatinine as a robust predictor of outcomes in patients treated with peritoneal dialysis.

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Peritoneal Transport Status Correlates With Morbidity But Not Longitudinal Change of Nutritional Status of Continuous Ambulatory Peritoneal Dialysis Patients: A 2-Year Prospective Study

Cited by 58 publications

References 24 publications

The Personal Dialysis Capacity Test Is Superior to the Peritoneal Equilibration Test to Discriminate Inflammation as the Cause of Fast Transport Status in Peritoneal Dialysis Patients

The Personal Dialysis Capacity Test Is Superior to the Peritoneal Equilibration Test to Discriminate Inflammation as the Cause of Fast Transport Status in Peritoneal Dialysis Patients

Meta-Analysis

Peritoneal Equilibration Test and Patient Outcomes

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