July 10, 2009

Peritoneal Protein Clearance and not Peritoneal Membrane Transport Status Predicts Survival in a Contemporary Cohort of Peritoneal Dialysis Patients

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In this observational study of patients receiving peritoneal dialysis, peritoneal protein clearance rather than peritoneal transport status was found to predict patient survival.

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Peritoneal Dialysis
  • Giancarlo Ruggieri

    An interesting paper. I think it could be useful to have informations on the rate of peritonitis episodes, in comparison with a control group without significative modifications of PCl , because the important influence of peritonitis on peritoneum functions, beyond the undoubted etiology by the vascular disease.

  • Jeffrey Perl

    These findings have not been replicated, however, there is RCT data to suggest that icodextrin-use improves fluid status and is associated with greater technique survival.

    Having said that, while Icodextrin may improve patient and technique survival via enhanced ultrafiltration in rapid transporters, it may also impact on the progressive changes in peritoneal membrane function seen with time.

    In a sub-cohort of patients in the EAPOS study, slower deterioration of peritoneal membrane function over time was seen in icodextrin-treated patients compared to those not treated with icodextrin. While baseline transport status does not predict survival, it is likely that progressive changes in transport status may be more informative as a marker of progressive and structural alterations in membrane function. While there are several methodologic limitations in the interpretation of the EAPOS data, it does suggest that ID and other glucose minimization strategies may play a role in augmenting peritoneal membrane injury and inflammation.

  • David Fields

    This is a fascinating article which further supports recent data suggesting that fast transporter status is not associated with worse outcomes.

    Given that the cohort in this study used a lot of icodextrin, this would suggest that the historical poor outcomes in fast transporters may be minimized by the use of icodextrin. Would others agree? Are there other more current patient cohorts that do not use icodextrin where these findings have been replicated?

    Anyone know?