Survival of Functionally Anuric Patients on Automated Peritoneal Dialysis

Brown, Edwina A.; Davies, Simon; Rutherford, Peter; Meeus, Frédérique; Borrás, M; Riegel, Werner; Filho, José C. Divino; Vonesh, Edward F.; Bree, Monique Van

doi:10.1097/01.asn.0000092146.67909.e2

Cited by 347 publications

(349 citation statements)

References 34 publications

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“…These peritoneal changes, coupled with loss of residual renal function, probably underlie the high prevalence of volume overload seen in many PD patients. Several studies (63)(64)(65) have shown an inverse relationship between daily peritoneal ultrafiltration volume and mortality, data that are consistent with the notion that reduced ultrafiltration capacity and consequent hypervolemia with increasing dialysis vintage may reverse the early survival advantage with PD.…”

Section: Possible Biologic Explanations For Differences In Outcomes Bsupporting

confidence: 58%

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Khawar

Kalantar-Zadeh

et al. 2007

Clinical Journal of the American Society of Nephrology

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In the past decade, peritoneal dialysis use among patients with end-stage renal disease has declined in many countries. Studies from the United States indicate that many academic centers do not have adequate resources to train fellows, most incident dialysis patients are not offered peritoneal dialysis, and more than half of dialysis clinics do not have the infrastructure to support peritoneal dialysis. Some are concerned that the outcomes of peritoneal dialysis and maintenance hemodialysis patients may not be equivalent, a notion that is not supported by outcome studies. Given the effect of modality selection on patients' lifestyle, attempts to conduct a randomized, controlled comparison of maintenance hemodialysis and peritoneal dialysis have been unsuccessful. Most observational studies showed that peritoneal dialysis is associated with a survival advantage that diminishes over time; it is unclear whether any of the differences over time are attributable to the modality. Between 1996 and 2003, the early outcomes of peritoneal dialysis patients further improved, whereas those for maintenance hemodialysis patients remained unchanged. Differences in outcomes may be due to residual statistical confounding; however, several biologic mechanisms can be postulated: The early survival advantage may be related to the better preservation of residual renal function with peritoneal dialysis, and the diminution of the survival advantage may be related to worsened volume control. There is a need for large observational and interventional studies among peritoneal dialysis patients to sustain and enforce the improvements in both dialysis therapies.

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Section: Possible Biologic Explanations For Differences In Outcomes Bsupporting

confidence: 58%

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Khawar

Kalantar-Zadeh

et al. 2007

Clinical Journal of the American Society of Nephrology

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“…Both of these treatment strategies benefit the impaired salt and water removal that is associated with fPTS. The disappearance of increased mortality risk of fPTS in other reported patient cohorts using APD and icodextrin would strongly suggest that fPTS is an intrinsic characteristic of membrane function that can be managed successfully (7)(8)(9). This argues against fPTS as solely a manifestation of systemic inflammation, which would be less responsive to the discussed treatment strategies.…”

Section: Discussionmentioning

confidence: 98%

“…Since 1998, increasing proportions of patients were treated with automated PD (APD), particularly when anuric, as described in the European Automated Peritoneal Dialysis Outcome Study (EAPOS) (9). In patients with solute transport Ͼ0.64 (as assessed by D/Pcr at 4 h) on PET testing), icodextrin was used with increased frequency.…”

Section: Study Design and Patient Populationmentioning

confidence: 99%

“…Because of an association between fPTS and hypoalbuminemia, it has been postulated that fPTS may be a manifestation of local or systemic inflammation while serving as a surrogate marker for the increased mortality seen with the malnutrition, inflammation, and atherosclerosis syndrome (6). Against this explanation is emerging evidence that fPTS does not seem to be associated with reduced survival and technique failure in contemporary cohorts (7)(8)(9).…”

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confidence: 99%

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Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

Perl¹,

Huckvale²,

Chellar³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Fast peritoneal membrane transport status may be due to inflammation or increased peritoneal membrane surface area. We evaluated the ability of peritoneal protein clearance (Pcl) to distinguish fast peritoneal membrane transport status as a consequence of peritoneal membrane inflammation and assess its impact on patient survival.Design, setting, participants, & measurements: Patients who initiated peritoneal dialysis at our center since January 1998 and had a baseline peritoneal equilibration test, measurement of dialysis adequacy, and 24-h dialysate Pcl were included. Demography, comorbidities, and biochemical data were prospectively collected. Follow-up was until death or the end of the period studied. Multivariate regression analysis identified factors that were associated with Pcl. A Cox proportional hazards model was used to identify factors that were associated with survival.Results: A total of 192 patients (56% men, mean age 54.3 ؎ 15.3; 32% with diabetes) were included. On univariate analysis, Pcl was negatively correlated with serum albumin and positively correlated with age, dialysate/plasma creatinine ratio (D/Pcr), the presence of peripheral vascular disease, and urine volume. On multivariate analysis, serum albumin, D/Pcr, urine volume, and peripheral vascular disease remained significant. Predictors of mortality were age, comorbidity grade, and Pcl but not D/Pcr.Conclusions: In this cohort, peritoneal transport status no longer predicted survival, whereas Pcl remained a predictor. Increased large-pore protein loss may reflect the severity of underlying cardiovascular disease, portending a poor prognosis for these patients.

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“…However, these patients still have an increased risk of mortality. In the European APD Outcomes (EAPOS) study, patients who did not achieve the target UF of 750 ml/d had an increased risk of mortality (P ϭ 0.0047) (50). Therefore, preservation of the PM is essential for improving long-term patient survival.…”

Section: Introductionmentioning

confidence: 99%

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

Kendrick

Teitelbaum

2010

Clinical Journal of the American Society of Nephrology

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The incidence and prevalence of ESRD in the United States continues to increase. Currently there are over 26,000 patients maintained on peritoneal dialysis. Mortality rates have fallen over the past several years, but long-term survival remains poor, with only 11% of peritoneal dialysis patients surviving past 10 years. Cardiovascular disease accounts for most deaths, and dialysis patients have many traditional and nontraditional cardiovascular risk factors. Lowering of these risk factors has not resulted in reduced cardiovascular morbidity and mortality in dialysis patients. Maneuvers to improve long-term peritoneal dialysis patient survival must therefore focus on modifiable risk factors including residual renal function, peritoneal membrane integrity, rate of infections, and peritoneal dialysis center size. This article reviews strategies for preserving residual renal function and peritoneal membrane integrity as well as strategies for reducing the rate of infections to enhance long-term survival in peritoneal dialysis patients.Clin J Am Soc Nephrol 5: 1123-1131, 2010. doi: 10.2215/CJN.04300709T he incidence and prevalence of ESRD continues to increase worldwide. In the United States alone there are over 480,000 patients on dialysis and the number of incident dialysis patients each year exceeds 100,000 (1). Peritoneal dialysis (PD) is an established treatment modality for patients with ESRD. Currently, 26,082 patients are maintained on PD in the United States (1). Mortality rates in ESRD patients have declined significantly over the past 20 years, but longterm survival remains poor, with the overall survival for all dialysis patients [hemodialysis (HD) and PD] being only 11%. These data were not censored for modality change, the effect of which is difficult to gauge. On a proportional basis, a greater percentage of PD than HD patients switch modality; however, in absolute numbers, more HD patients transition to PD than the reverse. Nevertheless, the overall adjusted probability of survival in incident PD patients at 1 year is 86.8%, but only 11.3% at 10 years (1). The reason for this dramatic decrease in patient survival over time is multifactorial and depends on several patient and dialysis center factors.There are several patient factors that affect survival on PD, most of which are nonmodifiable. Age, presence of diabetes, ESRD etiology, and ESRD vintage are all independent predictors of patient survival (2). For each 1-year increase in age, the risk of death increases by 4% [adjusted hazard ratio (HR) 1.04, P Ͻ 0.0001]. Patients with diabetes have a 30% increased risk of death compared with nondiabetic patients, and dialysis-naive patients have a 28% decreased risk of death compared with patients transferred from HD (2). Cardiovascular disease (CVD) accounts for most deaths in dialysis patients (approximately 50%). The genetics of the patient may be another nonmodifiable determinant of CVD. For example, a recent study of 1200 HD patients found an increased risk of CVD in patients with a specific complemen...

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Survival of Functionally Anuric Patients on Automated Peritoneal Dialysis

Cited by 347 publications

References 34 publications

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Is the Declining Use of Long-Term Peritoneal Dialysis Justified by Outcome Data?

Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

Strategies for Improving Long-Term Survival in Peritoneal Dialysis Patients

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