High Peritoneal Permeability is Not Associated with Higher Mortality or Technique Failure in Patients on Automated Peritoneal Dialysis

Abstract

Background

Patients on continuous ambulatory peritoneal dialysis (CAPD) who have high small-molecule peritoneal transport have increased mortality.

Objective

To investigate the impact of baseline peritoneal transport characteristics on patient and technique survival in incident peritoneal dialysis (PD) patients, most of whom are on automated PD (APD), with the use of icodextrin.

Design

Retrospective observational cohort study.

Setting

A single PD unit.

Patients and Methods

193 new patients that began PD between January 2000 and September 2004, and had an initial peritoneal equilibration test within 6 months of commencement of PD. Patients were divided into low (L), low average (LA), high average (HA), and high (H) peritoneal transport groups. Death-censored technique failure and patient survival were examined.

Results

Of the 193 patients, 151 (78.1%) were on APD or on APD with icodextrin or on CAPD with icodextrin. At the end of 1, 3, and 5 years, patient survival was 91%, 82%, and 67% in LA group; 95%, 77%, and 69% in HA group; and 96%, 71%, and 71% in H group. Technique survival was 100%, 90%, and 77% in LA group; 96%, 84%, and 72% in HA group; and 92%, 87%, and 77% in H group. High peritoneal permeability did not predict worse patient survival or technique failure, while age, diabetes, a lower glomerular filtration rate, and high body mass index (≥ 30 kg/m²) were independent predictors of death.

Conclusion

This study suggests that higher peritoneal transport is not a significant independent risk factor for either mortality or death-censored technique failure. The favorable outcome for high transporters in this study may be due to improved management of volume status by the increased use of APD and the use of icodextrin-based dialysis fluid.

Keywords

Peritoneal transport status patient survival technique failure

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References

Selgas

, Bajo

M.A.

, Cirugeda

, del Peso

, Valdes

, Castro

M.J.

Ultrafiltration and small solute transport at initiation of PD: questioning the paradigm of peritoneal function.

Perit Dial Int 2005; 25: 68–76.

Heaf

Pathogenic effects of a high peritoneal transport rate.

Semin Dial 2000; 13: 188–93.

Churchill

D.N.

, Thorpe

K.E.

, Nolph

K.D.

, Keshaviah

P.R.

, Oreopoulos

D.G.

, Page

Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients.

J Am Soc Nephrol 1998; 9: 1285–92.

Chung

S.H.

, Chu

W.S.

, Lee

H.A.

, Kim

Y.H.

, Lee

I.S.

, Lindholm

Peritoneal transport characteristics, comorbid diseases and survival in CAPD patients.

Perit Dial Int 2000; 20: 541–7.

Davies

S.J.

, Phillips

, Russell

G.I.

Peritoneal solute transport predicts survival on CAPD independently of residual renal function.

Nephrol Dial Transplant 1998; 13: 962–8.

Rumpsfeld

, McDonald

S.P.

, Johnson

D.W.

Higher peritoneal transport status is associated with higher mortality and technique failure in the Australian and New Zealand peritoneal dialysis patient populations.

J Am Soc Nephrol 2006; 17: 271–8.

Brimble

K.S.

, Walker

, Margetts

P.J.

, Kundhal

K.K.

, Rabbat

C.G.

Meta-analysis: peritoneal membrane transport, mortality, and technique failure in peritoneal dialysis.

J Am Soc Nephrol 2006; 17: 2591–8.

Passadakis

P.S.

, Thodis

E.D.

, Panagoutsos

S.A.

, Selisiou

C.A.

, Pitta

E.M.

, Vargemezis

V.A.

Clinical outcome in continuous ambulatory peritoneal dialysis patients is not influenced by high peritoneal transport status.

Perit Dial Int 2001; 21(Suppl 3): S80–5.

Paniagua

, Amato

, Vonesh

, Correa-Rotter

, Ramos

, Moran

; Mexican Nephrology Collaborative Study Group. Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis: ADEMEX, a prospective, randomized, controlled trial. J Am Soc Nephrol 2002; 13: 1307–20.

10.

Brown

E.A.

, Davies

S.J.

, Rutherford

, Meeus

, Borras

, Riegel

; EAPOS Group. Survival of functionally anuric patients on automated peritoneal dialysis: the European APD Outcome Study. J Am Soc Nephrol 2003; 14: 2948–57.

11.

Chung

S.H.

, Heimburger

, Stenvinkel

, Wang

, Lindholm

Influence of peritoneal transport rate, inflammation, and fluid removal on nutritional status and clinical outcome in prevalent peritoneal dialysis patients.

Perit Dial Int 2003; 23: 174–83.

12.

Rodrigues

A.S.

, Almeida

, Fonseca

, Martins

, Carvalho

M.J.

, Silva

Peritoneal fast transport in incident peritoneal dialysis patients is not consistently associated with systemic inflammation.

Nephrol Dial Transplant 2006; 21: 763–9.

13.

Fernandez Reyes

M.J.

, Bajo

M.A.

, Hevia

, del Peso

, Ros

, de Miguel

A.G.

Inherent high peritoneal transport and ultrafiltration deficiency: their mid-term clinical relevance.

Nephrol Dial Transplant 2007; 22: 218–23.

14.

Churchill

D.N.

, Taylor

D.W.

, Keshaviah

P.R.

for the CANUSA Peritoneal Dialysis Study Group. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes. J Am Soc Nephrol 1996; 7: 198–207.

15.

Baker

I.P.

, Detsky

A.S.

, Wesson

D.E.

Nutritional assessment: a comparison of clinical judgment and objective measurements.

N Engl J Med 1982; 306: 969–72.

16.

Twardowski

Z.J.

, Nolph

K.D.

, Khanna

Peritoneal equilibration test.

Perit Dial Bull 1987; 7: 138–47.

17.

Ates

, Nergizoglu

, Keven

, Sen

, Kutlay

, Erturk

Effect of fluid and sodium removal on mortality in peritoneal dialysis patients.

Kidney Int 2001; 60: 767–76.

18.

Tzamaloukas

A.H.

, Saddler

M.C.

, Murata

G.H.

, Malhotra

, Sena

, Simon

Symptomatic fluid retention in patients on continuous peritoneal dialysis.

J Am Soc Nephrol 1995; 6: 198–206.

19.

Bargman

J.M.

, Thorpe

K.E.

, Churchill

D.N.

Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis: a reanalysis of the CANUSA study.

J Am Soc Nephrol 2001; 12: 2158–62.

20.

W.K.

, Ho

Y.W.

, Li

C.S.

, Wong

K.S.

, Chan

T.M.

, Yu

A.W.

Effect of Kt/V on survival and clinical outcome in CAPD patients in a randomized prospective study.

Kidney Int 2003; 64: 649–56.

21.

Konings

C.J.

, Kooman

J.P.

, Schonck

, Dammers

, Cheriex

, Palmans Meulemans

A.P.

Fluid status, blood pressure, and cardiovascular abnormalities in patients on peritoneal dialysis.

Perit Dial Int 2002; 22: 477–87.

22.

Cheng

L.T.

, Tang

, Wang

Strong association between volume status and nutritional status in peritoneal dialysis patients.

Am J Kidney Dis 2005; 45: 891–902.

23.

Nolph

K.D.

, Moore

H.L.

, Prowant

Continuous peritoneal dialysis with a high flux membrane.

ASAJO J 1993; 39: 904–9.

24.

Churchill

D.N.

Patient selection for automated peritoneal dialysis on the basis of peritoneal transport characteristics.

Contrib Nephrol 1999; 129: 69–74.

25.

Chung

S.H.

, Heimbürger

, Lindholm

, Lee

H.B.

Peritoneal dialysis patient survival: a comparison between a Swedish and a Korean centre.

Nephrol Dial Transplant 2005; 20: 1207–13.

26.

C.H.

, Huang

C.C.

, Huang

J.Y.

, Wu

M.S.

, Leu

M.L.

High flux peritoneal membrane is a risk factor in survival of CAPD treatment.

Adv Perit Dial 1996; 12: 105–9.

27.

Wang

, Heimburger

, Waniewski

, Bergstrom

, Lindholm

Increased peritoneal permeability is associated with decreased fluid and small-solute removal and higher mortality in CAPD patients.

Nephrol Dial Transplant 1998; 13: 1242–9.

28.

Davies

S.J.

, Brown

E.A.

, Reigel

, Clutterbuck

, Heimburger

, Diaz

N.V.

; EAPOS Group. What is the link between poor ultrafiltration and increased mortality in anuric patients on automated peritoneal dialysis? Analysis of data from EAPOS. Perit Dial Int 2006; 26: 458–65.

29.

Davies

S.J.

Exploring new evidence of the clinical benefits of icodextrin solutions.

Nephrol Dial Transplant 2006; 21(Suppl 2): ii47–ii50.

30.

Wolfson

, Piraino

, Hamburger

R.J.

, Mortin

; for the Icodextrin Study Group. A randomized controlled trial to evaluate the efficacy and safety of icodextrin in peritoneal dialysis. Am J Kidney Dis 2002; 40: 1055–65.

31.

Plum

, Gentile

, Verger

, Brunkhorst

, Bahner

, Faller

Efficacy and safety of a 7. 5% icodextrin peritoneal dialysis solution in patients treated with automated peritoneal dialysis.

Am J Kidney Dis 2002; 39: 862–71.

32.

Finkelstein

, Healy

, Abu-Alfa

, Ahmad

, Brown

, Gehr

Superiority of icodextrin compared with 4. 25% dextrose for peritoneal ultrafiltration.

J Am Soc Nephrol 2005; 16: 546–54.

33.

Johnson

D.W.

, Arndt

, O'Shea

, Watt

, Hamilton

, Vincent

Icodextrin as salvage therapy in peritoneal dialysis patients with refractory fluid overload.

BMC Nephrol 2001; 2: 2.

34.

Davies

S.J.

, Brown

E.A.

, Frandsen

N.E.

, Rodrigues

A.S.

, Rodriguez-Carmona

, Vychytil

; EAPOS Group. Longitudinal membrane function in functionally anuric patients treated with APD: data from EAPOS on the effects of glucose and icodextrin prescription. Kidney Int 2005; 67: 1609–15.

35.

Heimburger

Peritoneal transport with icodextrin solution.

Contrib Nephrol 2006; 150: 97–103.

36.

Jeloka

T.K.

, Ersoy

F.F.

, Yavuz

, Sahu

K.M.

, Camsari

, Utah

What is the optimal dwell time for maximizing ultra-filtration with icodextrin exchange in automated peritoneal dialysis patients?

Perit Dial Int 2006; 26: 336–40.

37.

Davies

S.J.

Mitigating peritoneal membrane characteristics in modern peritoneal dialysis therapy.

Kidney Int Suppl 2006; 70: S76–83.

38.

Rumpsfeld

, McDonald

S.P.

, Purdie

D.M.

, Collins

, Johnson

D.W.

Predictors of baseline peritoneal transport status in Australian and New Zealand peritoneal dialysis patients.

Am J Kidney Dis 2004; 43: 492–501.

39.

Raj

D.S.

, Langos

, Gangam

, Roscoe

Ethnic variability in peritoneal equilibration test and urea kinetics.

Am J Kidney Dis 1997; 30: 374–81.