title: Increases in peritoneal small solute transport in the first month of peritoneal dialysis predict technique survival.
abstract: BACKGROUND
  Peritoneal transport of small solutes generally increases during the first month of peritoneal dialysis (PD). The aim of this study was to prospectively evaluate the ability of the peritoneal equilibration test (PET), carried out 1 and 4 weeks after the commencement of PD, to predict subsequent technique survival.
  
  
  METHODS
  Fifty consecutive patients commencing PD at the Princess Alexandra Hospital between 1 February 2001 and 31 May 2003 participated in the study. Paired 1 week and 1 month PET data were collated and correlated with subsequent technique survival.
  
  
  RESULTS
  A significant increase was observed in the dialysate : plasma creatinine ratio at 4 h (D/P Cr) between 1 and 4 weeks after the onset of PD (0.55 +/- 0.12 vs 0.66 +/- 0.11, P <0.001). Mean death-censored technique survival was superior in patients who experienced > or =20% rise in D/P Cr during the first month of PD compared with those who did not (2.3 +/- 0.2 vs 1.6 +/- 0.2 years, P <0.05). Using a multivariate Cox proportional hazards model analysis, the significant independent predictors of death-censored technique survival were an increase in D/P Cr of greater than 20% during the first month (adjusted hazard ratio [HR] 0.20, 95% CI 0.05-0.75), the absence of diabetes mellitus, the absence of ischaemic heart disease, body mass index and baseline peritoneal creatinine clearance.
  
  
  CONCLUSIONS
  A 20% or greater rise in D/P Cr during the first month of commencing PD is independently predictive of PD technique survival. Further investigations of the mechanisms underlying this phenomenon are warranted.
authors.affiliation: Department of Renal Medicine, University of Queensland, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Wiggins
authors.forename: Sophie
authors.initials: S
authors.lastname: Blizzard
authors.forename: Mary
authors.initials: M
authors.lastname: Arndt
authors.forename: Amanda
authors.initials: A
authors.lastname: O'Shea
authors.forename: Rhonda
authors.initials: R
authors.lastname: Watt
authors.forename: Jan
authors.initials: J
authors.lastname: Hamilton
authors.forename: Sharon
authors.initials: S
authors.lastname: Cottingham
authors.forename: Scott B
authors.initials: SB
authors.lastname: Campbell
authors.forename: Nicole M
authors.initials: NM
authors.lastname: Isbel
authors.forename: David W
authors.initials: DW
authors.lastname: Johnson
mesh_terms: D001692:Biological Transport; D003404:Creatinine / Q000097:blood; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010537:Peritoneum / Q000378:metabolism*; D016016:Proportional Hazards Models; D016019:Survival Analysis; D014508:Urea / Q000097:blood
chemical_list: D014508:Urea; D003404:Creatinine