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.
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.
Authors: Edwina A Brown; Simon J Davies; Peter Rutherford; Frederique Meeus; Mercedes Borras; Werner Riegel; Jose C Divino Filho; Edward Vonesh; Monique van Bree Journal: J Am Soc Nephrol Date: 2003-11 Impact factor: 10.121
Authors: Biju John; B Kay Tan; Stephen Dainty; Patrik Spanel; David Smith; Simon J Davies Journal: Clin J Am Soc Nephrol Date: 2010-06-10 Impact factor: 8.237
Authors: Olga Balafa; Nynke Halbesma; Dirk G Struijk; Friedo W Dekker; Raymond T Krediet Journal: Clin J Am Soc Nephrol Date: 2010-11-11 Impact factor: 8.237
Authors: Mark Lambie; James Chess; Kieron L Donovan; Yong Lim Kim; Jun Young Do; Hi Bahl Lee; Hyunjin Noh; Paul F Williams; Andrew J Williams; Sara Davison; Marc Dorval; Angela Summers; John D Williams; John Bankart; Simon J Davies; Nicholas Topley Journal: J Am Soc Nephrol Date: 2013-09-05 Impact factor: 10.121