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Increases in peritoneal small solute transport in the first month of peritoneal dialysis predict technique survival
Author(s) -
WIGGINS KATHRYN J,
BLIZZARD SOPHIE,
ARNDT MARY,
O'SHEA AMANDA,
WATT RHONDA,
HAMILTON JAN,
COTTINGHAM SHARON,
CAMPBELL SCOTT B,
ISBEL NICOLE M,
JOHNSON DAVID W
Publication year - 2004
Publication title -
nephrology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.752
H-Index - 61
eISSN - 1440-1797
pISSN - 1320-5358
DOI - 10.1111/j.1440-1797.2004.00325.x
Subject(s) - medicine , peritoneal dialysis , peritoneal equilibration test , hazard ratio , proportional hazards model , creatinine , survival analysis , body mass index , dialysis , urology , gastroenterology , surgery , confidence interval , continuous ambulatory peritoneal dialysis
SUMMARY: Background: Peritoneal transport of small solutes generally increases during the first month of peritoneal dialysis (PD). The aim of this study was to prospectively evaluate the ability of the peritoneal equilibration test (PET), carried out 1 and 4 weeks after the commencement of PD, to predict subsequent technique survival. Methods: Fifty consecutive patients commencing PD at the Princess Alexandra Hospital between 1 February 2001 and 31 May 2003 participated in the study. Paired 1 week and 1 month PET data were collated and correlated with subsequent technique survival. Results: A significant increase was observed in the dialysate : plasma creatinine ratio at 4 h (D/P Cr) between 1 and 4 weeks after the onset of PD (0.55 ± 0.12 vs 0.66 ± 0.11, P < 0.001). Mean death‐censored technique survival was superior in patients who experienced ≥20% rise in D/P Cr during the first month of PD compared with those who did not (2.3 ± 0.2 vs 1.6 ± 0.2 years, P < 0.05). Using a multivariate Cox proportional hazards model analysis, the significant independent predictors of death‐censored technique survival were an increase in D/P Cr of greater than 20% during the first month (adjusted hazard ratio [HR] 0.20, 95% CI 0.05–0.75), the absence of diabetes mellitus, the absence of ischaemic heart disease, body mass index and baseline peritoneal creatinine clearance. Conclusions: A 20% or greater rise in D/P Cr during the first month of commencing PD is independently predictive of PD technique survival. Further investigations of the mechanisms underlying this phenomenon are warranted.