Survival of functionally anuric patients on automated peritoneal dialysis: the European APD Outcome Study.
The European APD Outcome Study (EAPOS) is a 2-yr, prospective, multicenter study of the feasibility and clinical outcomes of automated peritoneal dialysis (APD) in anuric patients. A total of 177 patients were enrolled with a median age of 54 yr (range, 21 to 91 yr). Previous median total time on dialysis was 38 mo (range, 1.6 to 259 mo), and 36% of patients had previously been on hemodialysis for >90 d. Diabetes and cardiovascular disease were present in 17% and 46% of patients, respectively. The APD prescription was adjusted at physician discretion to aim for creatinine clearance (Ccrea) >/=60 L/wk per 1.73 m(2) and ultrafiltration (UF) >/=750 ml/24 h during the first 6 mo. Baseline solute transport status (D/P) was determined by peritoneal equilibration test. At 1 yr, 78% and 74% achieved Ccrea and UF targets, respectively; median drained dialysate volume was 16.2 L/24 h with 50% of patients using icodextrin. Baseline D/P was not related to UF achieved at 1 yr. At 2 yr, patient survival was 78% and technique survival was 62%. Baseline predictors of poor survival were age (>65 yr; P = 0.006), nutritional status (Subjective Global Assessment grade C; P = 0.009), diabetic status (P = 0.008), and UF (<750 ml/24 h; P = 0.047). Time-averaged analyses showed that age, Subjective Global Assessment grade C and diabetic status predicted patient survival with UF the next most significant variable (risk ratio, 0.5/L per d; P = 0.097). Baseline Ccrea, time-averaged Ccrea, and baseline D/P had no effect on patient or technique survival. This study shows that anuric patients can successfully use APD. Baseline UF, not Ccrea or membrane permeability, is associated with patient survival.
Charing Cross Hospital, London, United Kingdom. e.a.brown@imperial.ac.uk
Edwina A
EA
Brown
Simon J
SJ
Davies
Peter
P
Rutherford
Frederique
F
Meeus
Mercedes
M
Borras
Werner
W
Riegel
Jose C
JC
Divino Filho
Edward
E
Vonesh
Monique
M
van Bree
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001002:Anuria / Q000378:metabolism / Q000401:mortality* / Q000628:therapy*; D003404:Creatinine / Q000378:metabolism*; D005060:Europe / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D011446:Prospective Studies; D015996:Survival Rate
D003404:Creatinine