title: Clinical benefits and tolerability of increased fill volumes in Japanese peritoneal dialysis patients.
abstract: BACKGROUND
  Increasing fill volume is an effective means of improving clearances in patients on peritoneal dialysis (PD). Since Japanese PD patients are physically smaller than their Western counterparts, there is some concern that PD patients in Japan may be unable to tolerate larger fill volumes.
  
  
  OBJECTIVE
  To determine patient tolerance and changes in solute clearance and net ultrafiltration resulting from increased fill volumes in Japanese patients on PD.
  
  
  METHODS
  Prospective double-blind study, randomizing patients to three different fill volumes (2.5% dextrose solution: 1.5 L, 2.0 L, or 2.5 L) administered in random order on three different occasions separated by 1 week.
  
  
  RESULTS
  Twenty-one patients with a mean age of 55.4 +/- 2.1 years and a mean body surface area of 1.66 +/- 0.03 m2 were studied. On a scale of 0 to 10, patients' mean discomfort scores were 2.14 +/- 0.59, 3.48 +/- 0.54, and 3.81 +/- 0.63 (p = 0.047) at the end of the 1.5-L, 2.0-L, and 2.5-L dwells, respectively. There were no reports of cramps or shortness of breath with any fill volume. Patients were able to correctly guess the actual fill volume for only 34 of the 63 total exchanges (54.0%). Increasing fill volume resulted in an incremental improvement in peritoneal creatinine clearance, from 3.74 +/- 0.16 to 4.49 +/- 0.21 (p < 0.001, 2.0 L vs 1.5 L) to 5.12 +/- 0.20 mL/minute (p< 0.001, 2.5 L vs 2.0 L) for 1.5-L, 2.0-L, and 2.5-L dwells, respectively. Peritoneal urea clearance also increased significantly, from 5.65 +/- 0.13 to 7.04 +/- 0.17 (p < 0.001, 2.0 L vs 1.5 L) and 8.16 +/- 0.29 mL/minute (p < 0.001, 2.5 L vs 2.0 L), with incremental increases in fill volume. Similarly, net ultrafiltration in a 4-hour dwell increased significantly with fill volume, from 255.24 +/- 24 mL with 1.5 L, to 356 +/- 24 (p < 0.004, 2.0 L vs 1.5 L) and 392 +/- 29 mL (p < 0.086, 2.5 L vs 2.0 L) in patients receiving 2.0 L and 2.5 L, respectively.
  
  
  CONCLUSIONS
  Increasing the fill volume results in improvement in solute clearance and net ultrafiltration in Japanese PD patients, with minimal increase in patient discomfort. A large percentage of patients were unable to identify the actual fill volume.
authors.affiliation: Division of Artificial Kidneys, Kyoto University Hospital, Japan. afukatsu@kuhp.kyoto-u.ac.jp
authors.forename: A
authors.initials: A
authors.lastname: Fukatsu
authors.forename: Y
authors.initials: Y
authors.lastname: Komatsu
authors.forename: H
authors.initials: H
authors.lastname: Senoh
authors.forename: H
authors.initials: H
authors.lastname: Miyai
authors.forename: Y
authors.initials: Y
authors.lastname: Tanaka
authors.forename: T
authors.initials: T
authors.lastname: Oiwa
authors.forename: M
authors.initials: M
authors.lastname: Nakauchi
authors.forename: R
authors.initials: R
authors.lastname: Kasori
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.forename: H
authors.initials: H
authors.lastname: Kawahara
authors.forename: N
authors.initials: N
authors.lastname: Mayber
authors.forename: L E
authors.initials: LE
authors.lastname: Yost
authors.forename: F G
authors.initials: FG
authors.lastname: Ogrinc
authors.forename: S
authors.initials: S
authors.lastname: Mujais
mesh_terms: D001830:Body Surface Area; D003404:Creatinine / Q000378:metabolism; D015314:Dialysis Solutions / Q000008:administration & dosage*; D004311:Double-Blind Method; D005260:Female; D005947:Glucose / Q000008:administration & dosage*; D017583:Hemodiafiltration; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D014508:Urea / Q000378:metabolism
chemical_list: D015314:Dialysis Solutions; D014508:Urea; D003404:Creatinine; D005947:Glucose