Blake PG, Spanner E, Lindsay RM
High creatinine excretion ratio is a good, rather than a bad,
prognostic indicator in peritoneal dialysis patients
Am Soc Nephrol
J Am Soc Nephrol (abstract)
(Sep) 7:1506 1996
The authors of this abstract analysed the value of the relationship
between a single measurement of the creatinine excretion (CrEx) ratio and
clinical outcomes over a
subsequent 12-month period in 43 PD patients. A high CrEx ratio [between
measured and predicted CrEx] has been previously proposed as a marker of
noncompliance with exchanges in PD patients. However, in this study,
technique failure [p <0.001]
and death [p < 0.05] were significantly more common in patients with a
LOW CrEx ratio, i.e., < 1, as compared to those with a CrEx ratio >
1.24.
They conclude that "High CrEx ratio is a predictor of good, rather than
poor, outcome in PD patients, perhaps because it is an index of nutrition,
and this further weakens the argument that it is a reliable marker of
noncompliance"
Comment: From the data available in this abstract it is difficult
to figure out its real statistical significance : drop out seems to have
been expressed in terms of percentages of patients present at the begining
of the study period, whereas mortality and drop out should better be
expressed by actuarial survival. For a such a short period (12 months) and
a group of 48 patients, the difference should be huge to be significant. In
addition we have no information on the previous duration on dialysis and on
the general characteristics of the two groups.
The interest of the abstract is to raise questions as to the real value of
CrEx ratio to predict compliance. A reading of the full manuscript
will be required for proper evaluation of the conclusions of the authors
that a higher creatinine excretion is beneficial. (Christian Verger
MD, Pontoise,
France)
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Am Soc Nephrol
Basic peritoneal dialysis :
Chronic PD regimens, adequacy, modeling
CRF by organ system :
Nutrition