Feasibility of adequate solute clearance in obese patients on peritoneal dialysis: a cross-sectional study.
BACKGROUND
It is widely assumed that obese patients are poorly suited for peritoneal dialysis (PD). Mathematical models predicting weight limits to achieve adequate solute clearance in anuric patients on continuous ambulatory PD therapy do not apply to the majority of obese patients on PD therapy.


METHODS
To define the extent to which obesity or large body size interferes with successful PD, the feasibility of achieving adequate solute clearance, defined by the Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines, was studied. We reviewed prospectively recorded data for 25 obese patients (body mass index > or = 29) from a group of 58 prevalent PD patients treated in an inner-city ambulatory dialysis center. Adequacy of solute clearances was assessed by comparing weekly Kt/V and weekly creatinine clearance (WCC) with those recommended by the K/DOQI. Adequacy also was examined separately for large patients, defined as those with total-body water (TBW) by the Watson and Watson equation of 48 L or greater. Similar analyses were performed separately for 10 anuric obese patients.


RESULTS
Eighty four percent and 88% of the 25 obese patients achieved K/DOQI targets for weekly Kt/V and WCC, respectively. Among the 10 anuric obese patients, 90% and 70% achieved these targets. Only 60% of those with TBW of 48 L or greater met the Kt/V target.


CONCLUSIONS
PD remains a viable option for obese patients with end-stage renal disease. It is possible for the majority of obese patients on PD therapy to achieve solute clearances recommended by the K/DOQI.
Shibagaki
Yugo
Y
Division of Nephrology and Department of Biostatistics and Research Epidemiology, Henry Ford Hospital, Detroit, MI, USA.
Faber
Mark D
MD
Divine
George
G
Shetty
Anupkumar
A
D015992:Body Mass Index; D003430:Cross-Sectional Studies; D015314:Dialysis Solutions / Q000493:pharmacokinetics*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000378:metabolism*; D010530:Peritoneal Dialysis / Q000379:methods*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014462:Ultrafiltration
D015314:Dialysis Solutions