Longitudinal membrane function in functionally anuric patients treated with APD: data from EAPOS on the effects of glucose and icodextrin prescription.
BACKGROUND
Peritoneal dialysis is associated with changes in membrane function that can lead eventually to ultrafiltration (UF) failure. Factors driving these changes are thought to include hypertonic glucose exposure, but previously reported associations are confounded by the presence of residual renal function.


METHODS
Longitudinal membrane function (solute transport and UF capacity) were measured annually in a prospective cohort of 177 functionally anuric patients as part of the European Automated Peritoneal Dialysis Outcomes Study (EAPOS). Subgroup analysis was performed according to glucose exposure and icodextrin use at baseline.


RESULTS
The whole cohort experienced an increase in solute transport and reduction in UF capacity at 12 and 24 months that could not be explained by informative censoring. These changes were accelerated and more severe in patients using either 2.27% or 3.86% glucose, or those not using icodextrin at baseline. These differences could not be explained by age, comorbidity score, previous time spent on renal replacement, differential dropout from the study, peritonitis rates, or, by definition, residual renal function. Patients using icodextrin at baseline had worse membrane function and were more likely to be diabetic. There was an association between membrane function changes and achieved 24-hour ultrafiltration over the 2-year study period.


CONCLUSIONS
Anuric automated peritoneal dialysis (APD) patients experience significant detrimental changes in membrane function over a relatively short time period. Glucose appears to enhance these changes independent of residual renal function. Icodextrin use in these circumstances is associated with less deterioration in membrane function.
Davies
Simon J
SJ
North Staffordshire Hospital, Stoke on Trent, UK; Charing Cross Hospital, London, UK. Simon.Davies1@compuserve.com
Brown
Edwina A
EA
Frandsen
Niels E
NE
Rodrigues
Anabela S
AS
Rodriguez-Carmona
Ana
A
Vychytil
Andreas
A
Macnamara
Evelyne
E
Ekstrand
Agneta
A
Tranaeus
Anders
A
Filho
Jose C Divino
JC
D001002:Anuria / Q000503:physiopathology*; D001331:Automation; D005260:Female; D005936:Glucans / Q000494:pharmacology*; D005947:Glucose / Q000494:pharmacology*; D015312:Hemodialysis Solutions; D006801:Humans; D000077607:Icodextrin; D008297:Male; D008567:Membranes, Artificial; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D010530:Peritoneal Dialysis / Q000379:methods*; D014462:Ultrafiltration
D005936:Glucans; D015312:Hemodialysis Solutions; D008567:Membranes, Artificial; D000077607:Icodextrin; D005947:Glucose