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Perit Dial Int 28(1): 82-92 2008
© 2008 International Society for Peritoneal Dialysis
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ORIGINAL ARTICLES

HIGH PERITONEAL PERMEABILITY IS NOT ASSOCIATED WITH HIGHER MORTALITY OR TECHNIQUE FAILURE IN PATIENTS ON AUTOMATED PERITONEAL DIALYSIS

Xiao Yang1,2, Wei Fang1, Joanne M. Bargman1 and Dimitrios G. Oreopoulos1

Peritoneal Dialysis Program,1 Toronto General Hospital, University Health Network, and University of Toronto, Toronto, Ontario, Canada; Department of Nephrology,2 The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, P.R. China

Correspondence to: D.G. Oreopoulos, University Health Network, Toronto, and University of Toronto, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. dgo{at}teleglobal.ca

{diamondsuit} Background: Patients on continuous ambulatory peritoneal dialysis (CAPD) who have high small-molecule peritoneal transport have increased mortality.

{diamondsuit} Objective: To investigate the impact of baseline peritoneal transport characteristics on patient and technique survival in incident peritoneal dialysis (PD) patients, most of whom are on automated PD (APD), with the use of icodextrin.

{diamondsuit} Design: Retrospective observational cohort study.

{diamondsuit} Setting: A single PD unit.

{diamondsuit} Patients and Methods: 193 new patients that began PD between January 2000 and September 2004, and had an initial peritoneal equilibration test within 6 months of commencement of PD. Patients were divided into low (L), low average (LA), high average (HA), and high (H) peritoneal transport groups. Death-censored technique failure and patient survival were examined.

{diamondsuit} Results: Of the 193 patients, 151 (78.1%) were on APD or on APD with icodextrin or on CAPD with icodextrin. At the end of 1, 3, and 5 years, patient survival was 91%, 82%, and 67% in LA group; 95%, 77%, and 69% in HA group; and 96%, 71%, and 71% in H group. Technique survival was 100%, 90%, and 77% in LA group; 96%, 84%, and 72% in HA group; and 92%, 87%, and 77% in H group. High peritoneal permeability did not predict worse patient survival or technique failure, while age, diabetes, a lower glomerular filtration rate, and high body mass index (≥30 kg/m2) were independent predictors of death.

{diamondsuit} Conclusion: This study suggests that higher peritoneal transport is not a significant independent risk factor for either mortality or death-censored technique failure. The favorable outcome for high transporters in this study may be due to improved management of volume status by the increased use of APD and the use of icodextrin-based dialysis fluid.

KEY WORDS: Peritoneal transport status; patient survival; technique failure.

Received 8 January 2007; accepted 18 September 2007.






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