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Article: Independent effects of residual renal function and dialysis adequacy on nutritional status and patient outcome in continuous ambulatory peritoneal dialysis
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TitleIndependent effects of residual renal function and dialysis adequacy on nutritional status and patient outcome in continuous ambulatory peritoneal dialysis
 
AuthorsSzeto, CC1
Lai, KN1
Wong, TYH1
Law, MC1
Leung, CB1
Yu, AWY1
Li, PKT1
 
KeywordsDialysis adequacy
Nutrition
Peritoneal dialysis
 
Issue Date1999
 
PublisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/ajkd
 
CitationAmerican Journal Of Kidney Diseases, 1999, v. 34 n. 6, p. 1056-1064 [How to Cite?]
 
AbstractDialysis adequacy has a major impact on outcome of continuous ambulatory peritoneal dialysis (CAPD) patients. However, there is a substantial confounding effect by residual renal function in most studies. We differentiated the effects of dialysis adequacy from those of residual renal function on nutritional status and outcome of CAPD patients. We identified 168 CAPD patients treated in our center between September 1995 and December 1996 and categorized them into three groups: 49 patients with an average total Kt/V of 1.93 ± 0.18 and a median residual glomerular filtration rate (GFR) of 0.07 mL/min/1.73m2 in the dialysis-dependent (DD) group; 48 patients with an average total Kt/V of 2.03 ± 0.25 and a residual GFR of 2.33 mL/min/1.73m2 in the residual renal function (RRF) group; and 71 patients with an average total Kt/V of 1.38 ± 0.22 and a residual GFR of 0.05 mL/min/1.73m2 in the control (CTL) group. They were followed-up for 1 year to compare baseline nutritional status and 1-year morbidity. Baseline normalized protein catabolic rates (NPCR) are 1.00 ± 0.20 and 0.96 ± 0.19 (for RRF and DD, respectively) versus 0.89 ± 0.16 g/kg/d for CTL (P < 0.01). Percentage lean body mass (%LBM) was 71.6 ± 9.8 and 71.5 ± 10.0 (for RRF and DD, respectively) versus 65.2 ± 8.5% for CTL (P < 0.001). No difference was seen in the nutritional status between RRF and DD groups. Duration of hospitalization for 1 year was 6.9 ± 11.8 days in the RRF group versus 14.9 ± 25.1 in the DD and 10.6 ± 11.6 days in the CTL groups (P < 0.05). The peritonitis rate was 44.4 patient-months for the RRF group, versus 13.6 for the DD and 12.9 for the CTL groups (P < 0.05). There also was a trend toward superior 1-year technique survival in the RRF group, but the number of observations was small. There was no difference in duration of hospitalization, peritonitis rate, and technique survival between the DD and CTL groups. Short-term morbidity in patients without residual renal function appears to be independent of total Kt/V, although Kt/V may have some effects on nutritional status. The assumption that renal and peritoneal clearances are equivalent must be carefully reexamined. Further studies on the effect of dialysis adequacy in patients without residual renal function are urgently needed.
 
ISSN0272-6386
2012 Impact Factor: 5.294
2012 SCImago Journal Rankings: 2.057
 
ISI Accession Number IDWOS:000084126000011
 
DC FieldValue
dc.contributor.authorSzeto, CC
 
dc.contributor.authorLai, KN
 
dc.contributor.authorWong, TYH
 
dc.contributor.authorLaw, MC
 
dc.contributor.authorLeung, CB
 
dc.contributor.authorYu, AWY
 
dc.contributor.authorLi, PKT
 
dc.date.accessioned2010-09-06T07:46:43Z
 
dc.date.available2010-09-06T07:46:43Z
 
dc.date.issued1999
 
dc.description.abstractDialysis adequacy has a major impact on outcome of continuous ambulatory peritoneal dialysis (CAPD) patients. However, there is a substantial confounding effect by residual renal function in most studies. We differentiated the effects of dialysis adequacy from those of residual renal function on nutritional status and outcome of CAPD patients. We identified 168 CAPD patients treated in our center between September 1995 and December 1996 and categorized them into three groups: 49 patients with an average total Kt/V of 1.93 ± 0.18 and a median residual glomerular filtration rate (GFR) of 0.07 mL/min/1.73m2 in the dialysis-dependent (DD) group; 48 patients with an average total Kt/V of 2.03 ± 0.25 and a residual GFR of 2.33 mL/min/1.73m2 in the residual renal function (RRF) group; and 71 patients with an average total Kt/V of 1.38 ± 0.22 and a residual GFR of 0.05 mL/min/1.73m2 in the control (CTL) group. They were followed-up for 1 year to compare baseline nutritional status and 1-year morbidity. Baseline normalized protein catabolic rates (NPCR) are 1.00 ± 0.20 and 0.96 ± 0.19 (for RRF and DD, respectively) versus 0.89 ± 0.16 g/kg/d for CTL (P < 0.01). Percentage lean body mass (%LBM) was 71.6 ± 9.8 and 71.5 ± 10.0 (for RRF and DD, respectively) versus 65.2 ± 8.5% for CTL (P < 0.001). No difference was seen in the nutritional status between RRF and DD groups. Duration of hospitalization for 1 year was 6.9 ± 11.8 days in the RRF group versus 14.9 ± 25.1 in the DD and 10.6 ± 11.6 days in the CTL groups (P < 0.05). The peritonitis rate was 44.4 patient-months for the RRF group, versus 13.6 for the DD and 12.9 for the CTL groups (P < 0.05). There also was a trend toward superior 1-year technique survival in the RRF group, but the number of observations was small. There was no difference in duration of hospitalization, peritonitis rate, and technique survival between the DD and CTL groups. Short-term morbidity in patients without residual renal function appears to be independent of total Kt/V, although Kt/V may have some effects on nutritional status. The assumption that renal and peritoneal clearances are equivalent must be carefully reexamined. Further studies on the effect of dialysis adequacy in patients without residual renal function are urgently needed.
 
dc.description.natureLink_to_subscribed_fulltext
 
dc.identifier.citationAmerican Journal Of Kidney Diseases, 1999, v. 34 n. 6, p. 1056-1064 [How to Cite?]
 
dc.identifier.epage1064
 
dc.identifier.hkuros50635
 
dc.identifier.isiWOS:000084126000011
 
dc.identifier.issn0272-6386
2012 Impact Factor: 5.294
2012 SCImago Journal Rankings: 2.057
 
dc.identifier.issue6
 
dc.identifier.openurl
 
dc.identifier.pmid10585315
 
dc.identifier.scopuseid_2-s2.0-0032740125
 
dc.identifier.spage1056
 
dc.identifier.urihttp://hdl.handle.net/10722/78787
 
dc.identifier.volume34
 
dc.languageeng
 
dc.publisherWB Saunders Co. The Journal's web site is located at http://www.elsevier.com/locate/ajkd
 
dc.publisher.placeUnited States
 
dc.relation.ispartofAmerican Journal of Kidney Diseases
 
dc.subjectDialysis adequacy
 
dc.subjectNutrition
 
dc.subjectPeritoneal dialysis
 
dc.titleIndependent effects of residual renal function and dialysis adequacy on nutritional status and patient outcome in continuous ambulatory peritoneal dialysis
 
dc.typeArticle
 
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<contributor.author>Wong, TYH</contributor.author>
<contributor.author>Law, MC</contributor.author>
<contributor.author>Leung, CB</contributor.author>
<contributor.author>Yu, AWY</contributor.author>
<contributor.author>Li, PKT</contributor.author>
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<description.abstract>Dialysis adequacy has a major impact on outcome of continuous ambulatory peritoneal dialysis (CAPD) patients. However, there is a substantial confounding effect by residual renal function in most studies. We differentiated the effects of dialysis adequacy from those of residual renal function on nutritional status and outcome of CAPD patients. We identified 168 CAPD patients treated in our center between September 1995 and December 1996 and categorized them into three groups: 49 patients with an average total Kt/V of 1.93 &#177; 0.18 and a median residual glomerular filtration rate (GFR) of 0.07 mL/min/1.73m2 in the dialysis-dependent (DD) group; 48 patients with an average total Kt/V of 2.03 &#177; 0.25 and a residual GFR of 2.33 mL/min/1.73m2 in the residual renal function (RRF) group; and 71 patients with an average total Kt/V of 1.38 &#177; 0.22 and a residual GFR of 0.05 mL/min/1.73m2 in the control (CTL) group. They were followed-up for 1 year to compare baseline nutritional status and 1-year morbidity. Baseline normalized protein catabolic rates (NPCR) are 1.00 &#177; 0.20 and 0.96 &#177; 0.19 (for RRF and DD, respectively) versus 0.89 &#177; 0.16 g/kg/d for CTL (P &lt; 0.01). Percentage lean body mass (%LBM) was 71.6 &#177; 9.8 and 71.5 &#177; 10.0 (for RRF and DD, respectively) versus 65.2 &#177; 8.5% for CTL (P &lt; 0.001). No difference was seen in the nutritional status between RRF and DD groups. Duration of hospitalization for 1 year was 6.9 &#177; 11.8 days in the RRF group versus 14.9 &#177; 25.1 in the DD and 10.6 &#177; 11.6 days in the CTL groups (P &lt; 0.05). The peritonitis rate was 44.4 patient-months for the RRF group, versus 13.6 for the DD and 12.9 for the CTL groups (P &lt; 0.05). There also was a trend toward superior 1-year technique survival in the RRF group, but the number of observations was small. There was no difference in duration of hospitalization, peritonitis rate, and technique survival between the DD and CTL groups. Short-term morbidity in patients without residual renal function appears to be independent of total Kt/V, although Kt/V may have some effects on nutritional status. The assumption that renal and peritoneal clearances are equivalent must be carefully reexamined. Further studies on the effect of dialysis adequacy in patients without residual renal function are urgently needed.</description.abstract>
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Author Affiliations
  1. Prince of Wales Hospital Hong Kong