Tzamaloukas AH, Dimitriadis A, Murata GH, Nicolopoulou N,
Malhotra D, Balaskas EV, Kakavas J, et al.
Continuous peritoneal dialysis is large weight individuals
XVIth Annual CAPD Conference
Perit Dial Int Suppl 2
(Feb) 16:S31 1996
This is another paper dealing with PD in large size patients (see also the
abstract by Fried et al). A number of authorities have
recently proposed that
patients weighing over 90-100 kg may not be suitable for PD because of the
inevitable problems
achieving higher solute clearance targets. The abstract by Tzamaloukas et al
is thus timely in that
it shows that such patients can achieve higher adequacy targets. They report
that 24 patients
weighing more than 100 kg were treated with APD in association with daytime
exchanges and that as
many of these patients achieved the acceptable creatinine clearance in KT/V
targets as did patients
who weighed less than 100 kg. Astonishingly, a greater proportion of
patients weighing more than
100 kg had an acceptable creatinine clearance as compared to those weighing
less than 100 kg. Even
in anuric patients over 100 kg, targets were as likely to be achieved as in
patients less than 100
kg.
Comment: Two points are pertinent. One is that the findings suggest
that the physicians made
a greater effort to achieve adequate prescriptions in patients who were heavy
than in those who were
not. The results was that, paradoxically, they did as well if not better in
the heavy patients as
they did in the less heavy. Secondly, the heavy patients had better small
solute clearance when
normalization was done to ideal rather than actual weights and body surface
areas. This implies
that these heavy patients were obese rather than muscular. Thus, the authors
have shown that it is
feasible to reach small solute adequacy targets in obese patients weighing
more than 100 kg, but
they have not shown that it is possible in the small proportion of patients
over 100 kg who are
predominantly muscular rather than obese. This is an important difference.
(Peter G. Blake,
M.D.)
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XVIth Annual CAPD Conference
Basic peritoneal dialysis :
Chronic PD regimens, adequacy, modeling