Journal of the American Society of Nephrology, Vol 7, 737-744, Copyright © 1996 by American Society of Nephrology

REGULAR ARTICLES

Dialysis adequacy and nutrition determine prognosis in continuous ambulatory peritoneal dialysis patients

L Fung, CA Pollock, RJ Caterson, JF Mahony, DA Waugh, C Macadam and LS Ibels
Department of Renal Medicine, Royal North Shore Hospital, Sydney, Australia.

Peritoneal membrane function was assessed in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) using parameters derived from urea kinetic modeling and the peritoneal equilibration test (PET). Their relationships with other nutritional markers and overall morbidity were determined. Data regarding the patients' nutritional status as determined by total body nitrogen (TBN) measurements, hospital admissions, and infectious complications within the last 12 months were reviewed. Total dialysate clearance (Kt/V) delivered was highly dependent on residual renal function (P < 0.0001). Kt/V derived from peritoneal clearance diminished with increasing age (P < 0.05). A higher delivered total Kt/V was associated with higher normalized protein catabolic rates (P < 0.002), which in turn were associated with improved TBN (P < 0.05). Hospital admissions decreased with improved normalized protein catabolic rates (P < 0.05), and higher serum albumin and total protein levels (P < 0.01 and P < 0.002, respectively). Infectious complications correlated positively with time on dialysis (P < 0.01), and correlated negatively with TBN measurements (P = 0.05). No correlations were found between infectious complications and serum albumin level or peritoneal protein loss. However, the total duration of hospitalization was shortened with higher serum albumin and total protein levels (P < 0.0001 and P < 0.002, respectively). Although Kt/V determinations did not correlate with clearances determined by the PET, the PET-determined creatinine transport rate correlated with TBN (P < 0.05) but not with infectious complications. In conclusion, nutritional parameters correlate with outcome on continuous ambulatory peritoneal dialysis. An integral relationship exists between nutritional status and dialysis delivery, which is best assessed by urea kinetic modeling.

This article has been cited by other articles:

				M. Rumpsfeld, S. P. McDonald, and D. W. Johnson 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., January 1, 2006; 17(1): 271 - 278. [Abstract] [Full Text] [PDF]

				J. Westhuyzen, K. Mills, and H. Healy Predicting Clinical Outcomes in Peritoneal Dialysis Patients Using Small Solute Modeling Ann. Clin. Lab. Sci., January 1, 2005; 35(1): 46 - 53. [Abstract] [Full Text] [PDF]

				R. T. Krediet The rise and fall of the Kt/V concept in CAPD Nephrol. Dial. Transplant., June 1, 2002; 17(6): 970 - 972. [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673