Churchill DN, Thorpe KE, Nolph KD, Oreopoulos DG, Page D,
Keshaviah PR
CAPD patient and technique survivals are worse with
increased membrane permeability
XVIth Annual CAPD Conference
Perit Dial Int Suppl 2
(Feb) 16:S21 1996
This abstract provides more fascinating information from the CANUSA database,
which is proving to be
a `goldmine' of information about adequacy and nutrition in CAPD. This
analysis, based on 503
CANUSA patients who had a PET done every six months, shows that the four hour
D/P Cr, analysed as a
time-dependent co-variant, is highly predictive of death and technique
survival in a Cox
proportional hazards model containing age, IDDM, cardiac disease, serum
albumin and renal
creatinine clearance. It appears that, in general, the lower the D/P Cr
value, the better the long
term outcome for patients. This fits in with findings by other authors some
years ago that high
peritoneal transport characteristics are associated with lower serum albumins
which are, in turn,
associated with adverse outcomes.
Comment: What is different about this study is that it suggests that
the adverse predictive
effect of the rapid transport status is independent of the serum albumin,
implying that another
mechanism for this deleterious effect needs to be suggested. Possibilities
are that the patients
with more rapid transport status have poorer control of hydration status, or
that their rapid
transport status is secondarily related in some unclear way to malnutrition
or to previous episodes
of peritonitis, each of which might explain the adverse outcomes. An
alternative possibility is
that there is some problem with statistical analysis here and that rapid
peritoneal transport and
serum albumin are so closely related that there may be an issue of
multicollinearity. This whole
issue requires further investigation.
(Peter G. Blake, M.D.)
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XVIth Annual CAPD Conference
Basic peritoneal dialysis :
Chronic PD regimens, adequacy, modeling
Basic peritoneal dialysis :
PET testing