Original InvestigationRandomized prospective study of the effect of increased dialytic dose on nutritional and clinical outcome in continuous ambulatory peritoneal dialysis patients*,**,*
Section snippets
Patients
Of the 122 patients undergoing CAPD for at least 12 months in the renal unit of Kwong Wah Hospital (Kowloon, Hong Kong) from April 1994 to May 1995, a total of 82 patients (47 men, 35 women; mean age, 53.7 years; range, 28 to 76 years) agreed to participate in the study. Patients on daytime ambulatory peritoneal dialysis (PD) or nightly intermittent PD therapy, those with amputations, or bedridden patients were excluded from the study. At the beginning of the study, patients had been undergoing
Results
Sixty-six of the 82 patients completed the 12-month study. The dropout rate was similar for the two groups (6 of 42 versus 10 of 40 patients; P = not significant [NS]). Six patients (6-L group, 2 patients; 8-L group, 4 patients) underwent transplantation. Four patients (2 patients in each group) died of cerebrovascular disease (3 patients) or intestinal obstruction secondary to fungal peritonitis (1 patient). Six patients (6-L group, 2 patients; 8-L group, 4 patients) were switched to
Discussion
CAPD is an increasingly used treatment modality for end-stage renal failure worldwide. It is preferred to hemodialysis in our population as a result of our unique socioeconomic background. Three daily 2-L exchanges has been the standard starting therapy for CAPD in most centers of Hong Kong because of a smaller body size in general. Our local data have confirmed that approximately 50% of PD patients have a weekly Kt/V less than the commonly agreed target of 1.7 for adequate dialysis.26 If we
Acknowledgements
Acknowledgment: The authors acknowledge the help of the renal nursing staff of Kwong Wah Hospital and Pamela Youde Polyclinic Renal Dialysis Center.
References (36)
- et al.
Lack of correlation between urea kinetic indices and clinical outcomes in CAPD patients
Kidney Int
(1991) - et al.
A longitudinal, five year survey of urea kinetic parameters in CAPD patients
Kidney Int
(1992) - et al.
Predictors of survival in continuous ambulatory peritoneal dialysis patients: The importance of prealbumin and other nutritional and metabolic markers
Am J Kidney Dis
(1994) - et al.
The normalized protein catabolic rate is a flawed marker of nutrition in CAPD patients
Kidney Int
(1994) - et al.
Total-body water volumes for adult males and females estimated from simple anthropometric measurements
Am J Clin Nutr
(1980) - et al.
Serum albumin in continuous peritoneal dialysis: Its predictors and relationship to urea clearance
Kidney Int
(1996) - et al.
Mechanisms of hypoalbuminemia in hemodialysis patients
Kidney Int
(1995) - et al.
Acute phase proteins and peritoneal dialysate albumin loss are the main determinants of serum albumin in peritoneal dialysis patients
Am J Kidney Dis
(1997) - et al.
A hypothesis: The protein catabolic rate is dependent upon the type and amount of treatment in dialyzed uremic patients
Am J Kidney Dis
(1989) - et al.
Morbidity and mortality of CAPD and hemodialysis
Kidney Int
(1993)
Clinical outcome of continuous ambulatory peritoneal dialysis predicted by urea and creatinine kinetics
J Am Soc Nephrol
Adequacy of dialysis and nutritional status in CAPD
Nephrol Dial Transplant
Urea kinetics has limited relevance in assessing adequacy of dialysis in CAPD
Adv Perit Dial
Adequacy of dialysis and nutrition in continuous peritoneal dialysis: Association with clinical outcomes
J Am Soc Nephrol
The correlation between Kt/V and protein catabolic rate—A self-fulfilling prophecy
Nephrol Dial Transplant
Which comes first, Kt/V or PCR—Chicken or egg?
Kidney Int Suppl
Answers to all your questions about peritoneal urea clearance and nutrition in CAPD patients
Perit Dial Int
Problems predicting continuous ambulatory peritoneal dialysis outcomes with small solute clearances
Perit Dial Int
Cited by (46)
KDOQI US Commentary on the 2020 ISPD Practice Recommendations for Prescribing High-Quality Goal-Directed Peritoneal Dialysis
2021, American Journal of Kidney DiseasesCitation Excerpt :Initiating long-term dialysis with PD results in amelioration of anorexia and gain in body weight. Intensifying PD treatment has not been shown to result in improvement in measures of protein-energy wasting.46,72 Furthermore, PD is associated with a daily loss of 6 to 8 g of protein in the dialysate effluent, and serum albumin levels in persons treated with PD are lower than for those treated with HD.73,74
Nutrition and the Kidney: Recommendations for Peritoneal Dialysis
2013, Advances in Chronic Kidney DiseasePeritoneal dialysis prescription and adequacy
2010, Chronic Kidney Disease, Dialysis, and Transplantation: A Companion to Brenner and Rector's The Kidney - Expert Consult: Online and PrintPeritoneal Dialysis Prescription and Adequacy
2010, Chronic Kidney Disease, Dialysis, and TransplantationAssociation of Kt/V and Creatinine Clearance With Outcomes in Anuric Peritoneal Dialysis Patients
2008, American Journal of Kidney DiseasesCitation Excerpt :In the study by Lo et al,4 there was a suggestion of increased morbidity in individuals randomly assigned to Kt/V less than 1.7 (more anemia with more need for epoetin, more withdrawn from the study). In a third smaller study from Hong Kong, Mak et al20 studied the effect of adding an additional exchange (from three 2-L exchanges [standard at that time] to 4 exchanges) in 82 patients. At 12 months, Kt/V was 1.67 in the group with 3 exchanges/d versus 2.02 for the group with 4 exchanges/d.
Adequacy of peritoneal dialysis
2008, Therapy in Nephrology and Hypertension: A Companion to Brenner & Rector's The Kidney, Expert Consult - Online and Print
- *
Received October 6, 1999; accepted in revised form January 28, 2000.
- **
Supported in part by a grant from the Baxter Healthcare Corporation.
- *
Address reprint requests to Siu-Ka Mak, MD, Renal Unit, Department of Medicine, Kwong Wah Hospital, 25 Waterloo Rd, Kowloon, Hong Kong. E-mail: [email protected]