Fried LF, Bernardini J, Piraino B
Neither size nor weight predicts survival in PD patients
XVIth Annual CAPD Conference
Perit Dial Int Suppl 2
(Feb) 16:S69 1996
This abstract, as does a companion abstract by Tzamaloukas et al
deals with the important question of the interrelationship between body
weight and adequacy of
peritoneal dialysis.
Existing adequacy studies showing correlations between small solute clearance
and outcome, have, to
some extent, been confounded by residual renal function, and no study has
clearly shown that
prospective increases in peritoneal clearance alone improve outcome. In a
situation where most
patients have the same peritoneal prescription of 4 x 2L a day - and this has
been widespread
practice until recently - body weight or surface area is obviously the major
determinant of
peritoneal clearance.
Fried et al therefore investigate, in 343 adult patients followed over 16
years, whether weight is a
determinant of patient and technique survival. They find, using the Cox
proportional hazards model,
that age, diabetes, peritonitis rate and initial serum albumin are
independent predictors of patient
survival, and that peritonitis rate is the only independent predictor of
technique survival. They
find no effect for weight or body surface area.
Comment: These findings are similar to those in the shortly to be
published CANUSA study. If
small solute clearance is important, it is surprising that weight is such a
poor predictor of
outcomes. It may be that the use of actual body weight to normalize solute
clearance is
inappropriate, as has been suggested by some authors. An alternative
explanation is that any
analysis of weight is confounded by the fact that high weight is often
associated with better
nutrition despite its simultaneous association with lower corrected
clearances. Thus, a well
nourished patient might be less adversely affected by inadequate dialysis, at
least in the short
term. This is
all part of the complicated interrelationship between dialytic dose,
nutrition and outcome. (Peter G. Blake, M.D.)
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XVIth Annual CAPD Conference
CRF: Problem Areas :
Outcomes (Morbidity, Mortality)