Peritoneal urea and creatinine clearances in continuous peritoneal dialysis patients with different types of peritoneal solute transport

Tzamaloukas, Antonios H.; Murata, Glen H.; Piraino, Beth; Rao, Panduranga S.; Bernardini, Judith; Malhotra, Deepak; Oreopoulos, Dimitrios G.

doi:10.1046/j.1523-1755.1998.00896.x

Cited by 33 publications

(27 citation statements)

References 19 publications

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“…Some other studies have also described that low average peritoneal membrane transporters tend to have efficient UF as compared to other peritoneal membrane transporters [13][14][15]. In addition, our patients with low/low average peritoneal membrane transporters demonstrated statistical significance in CrCl.…”

Section: Discussionsupporting

confidence: 70%

“…In addition, our patients with low/low average peritoneal membrane transporters demonstrated statistical significance in CrCl. Other published studies suggesting that CrCl may deteriorate in low peritoneal membrane transporters and Kt/V may not vary significantly between the peritoneal membrane transporters [13,[20][21][22][23]. In this study, Kt/V did not vary statistically (p=0.93) both in low/low average and high/ high average peritoneal membrane transporters and it is possibly due to the subtle difference between the approximate and calculated dwell time especially in high peritoneal membrane transporters.…”

Section: Discussionmentioning

confidence: 93%

“…Further, peritoneal membrane slow transporters have sustained osmotic gradient and tend to have better UF and poor small molecule clearance. In contrast, high peritoneal membrane transporters have a rapid osmotic gradient and tend to have better small molecule clearance and poor UF [13][14][15][16][17]. Importantly, osmotic gradient tends to shift only after maximizing the dwell point, hence with optimization of dwell time using APEX time, low/and high peritoneal transporters tend to work efficiently well in relation to UF as compared to CrCl.…”

Section: Discussionmentioning

confidence: 99%

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Value of accelerated peritoneal examination time in pediatric nocturnal intermittent peritoneal dialysis

Azar¹,

Yeo²,

Omair³

et al. 2017

Vascul Dis Ther

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

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Value of accelerated peritoneal examination time in pediatric nocturnal intermittent peritoneal dialysis

Azar¹,

Yeo²,

Omair³

et al. 2017

Vascul Dis Ther

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“…In two studies, K p t / V Urea values did not differ between patients with low, low‐average, high‐average, and high peritoneal transport in patients on CAPD with four daily exchanges (25,26). Size indicators did not differ between the four transport groups in one of these two studies (26). Finally, a recent study (27) tested separately the accuracy of Dv/ V and D / P Urea values in predicting K p t / V Urea values ≥1.70 weekly in CAPD patients (Fig.…”

Section: Prevention Of Uremiamentioning

confidence: 97%

The Prescription of Peritoneal Dialysis

Tzamaloukas

Raj

Onime

et al. 2008

Seminars in Dialysis

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In addition to the maintenance of normal extracellular electrolyte composition, the prescription of continuous peritoneal dialysis (CPD) should address four other specific issues: (i) prevention of uremia by achievement of adequate clearance of azotemic substances, (ii) prevention of progressive expansion of the extracellular volume by adequate peritoneal ultrafiltration, (iii) prevention of loss of residual renal function, and (iv) prevention of deterioration of the peritoneal membrane structure and function. Urea clearance, in the form of Kt/V(Urea), is the index of removal of azotemic substances proposed by current guidelines. The target total (renal plus peritoneal) Kt/V(Urea) is >or=1.7 weekly. To provide the desired peritoneal Kt/V(Urea) (K(p)t/V(Urea)), the prescription of peritoneal dialysis must provide a daily drain volume (Dv) defined by the clearance equations as Dv = V x (K(p)t/V(Urea))/(D/P(Urea)), where V is body water obtained from published anthropometric formulas, K(p)t/V(Urea) = (1.7 - renal Kt/V(Urea))/7 and D/P(Urea) is the dialysate-to-plasma urea concentration ratio at the dwell time prescribed. Computer programs obtain the relevant D/P(Urea) values from formal studies of peritoneal transport. In the absence of these studies (for example, at initiation of CPD), D/P(Urea) values can be obtained from published studies with similar dwell times. Body size, indicated by V, is the major determinant of the K(p)t/V(Urea) limit provided by a given CPD schedule. Other obstacles to achievement of adequate urea clearance are created by poor patient compliance, inaccuracies of the anthropometric formulas estimating V, and mechanical complications of CPD that lead to retention of dialysate in the body. The main requirements for the prescription of adequate ultrafiltration are knowledge of the individual peritoneal transport characteristics, monitoring of urinary volume, and restriction of dietary sodium intake. Excessive dietary sodium intake is the major cause of extracellular volume expansion in CPD. Ideally, sodium intake should be kept at the level of total (peritoneal plus renal) sodium removal. Preventing the loss of residual renal function involves avoidance of nephrotoxic influences in the form of medications, radiocontrast agents, urinary obstruction and infection, and possibly other influences, such an elevated calcium-phosphorus product and anemia. Use of the lowest dialysate dextrose concentration that will allow adequate ultrafiltration is currently the most widespread practical measure of prevention of peritoneal membrane deterioration. Formulation of biocompatible dialysate is a major ongoing research effort and may greatly enhance the success of CPD in the future.

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“…This relation is expressed as [Cr] S = P Cr /C Cr . Consequently, variations in C Cr in patients on PD can result in variations in [Cr] S that are unrelated to muscle mass[4]. …”

Section: Introductionmentioning

confidence: 99%

Reproducibility of serial creatinine excretion measurements in peritoneal dialysis

Murata

Sun

et al. 2017

WJN

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AIMTo test whether muscle mass evaluated by creatinine excretion (EXCr) is maintained in patients with end-stage kidney disease (ESKD) treated by peritoneal dialysis (PD), we evaluated repeated measurements of EXCr in a PD population.METHODSOne hundred and sixty-six PD patients (94 male, 72 female) receiving the same PD dose for the duration of the study (up to approximately 2.5 years) had repeated determinations of total (in urine plus spent dialysate) 24-h EXCr (EXCr T) to assess the adequacy of PD by creatinine clearance. All 166 patients had two EXCr T determinations, 84 of the 166 patients had three EXCr T determinations and 44 of the 166 patients had four EXCr T measurements. EXCr T values were compared using the paired t test in the patients who had two studies and by repeated measures ANOVA in those who were studied three or four times.RESULTSIn patients who were studied twice, with the first and second EXCr T measurements performed at 9.2 ± 15.2 mo and 17.4 ± 15.8 mo after onset of PD, respectively, EXCr T did not differ between the first and second study. In patients studied three times and whose final assessment occurred 24.7 ± 16.3 mo after initiating PD, EXCr T did not differ between the first and second study, but was significantly lower in the third study compared to the first study. In patients who were studied four times and whose fourth measurement was taken 31.9 ± 16.8 mo after onset of PD, EXCr T did not differ between any of the studies. The average EXCr T value did not change significantly, with the exception of the third study in the patients studied thrice. However, repeated determinations of EXCr T in individuals showed substantial variability, with approximately 50% of the repeated determinations being higher or lower than the first determination by 15% or more.CONCLUSIONThe average value of EXCr T remains relatively constant for up to 2.5 years of follow-up in PD patients who adhere to the same PD schedule. However, repeated individual EXCr T values vary considerably in a large proportion of the patients. Further studies are needed to evaluate the clinical significance of varying EXCr T values and the stability of EXCr T beyond 2.5 years of PD follow-up.

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Peritoneal urea and creatinine clearances in continuous peritoneal dialysis patients with different types of peritoneal solute transport

Cited by 33 publications

References 19 publications

Value of accelerated peritoneal examination time in pediatric nocturnal intermittent peritoneal dialysis

Value of accelerated peritoneal examination time in pediatric nocturnal intermittent peritoneal dialysis

The Prescription of Peritoneal Dialysis

Reproducibility of serial creatinine excretion measurements in peritoneal dialysis

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