High peritoneal permeability is not associated with higher mortality or technique failure in patients on automated peritoneal dialysis.
BACKGROUND
Patients on continuous ambulatory peritoneal dialysis (CAPD) who have high small-molecule peritoneal transport have increased mortality.


OBJECTIVE
To investigate the impact of baseline peritoneal transport characteristics on patient and technique survival in incident peritoneal dialysis (PD) patients, most of whom are on automated PD (APD), with the use of icodextrin.


METHODS
Retrospective observational cohort study.


METHODS
A single PD unit.


METHODS
193 new patients that began PD between January 2000 and September 2004, and had an initial peritoneal equilibration test within 6 months of commencement of PD. Patients were divided into low (L), low average (LA), high average (HA), and high (H) peritoneal transport groups. Death-censored technique failure and patient survival were examined.


RESULTS
Of the 193 patients, 151 (78.1%) were on APD or on APD with icodextrin or on CAPD with icodextrin. At the end of 1, 3, and 5 years, patient survival was 91%, 82%, and 67% in LA group; 95%, 77%, and 69% in HA group; and 96%, 71%, and 71% in H group. Technique survival was 100%, 90%, and 77% in LA group; 96%, 84%, and 72% in HA group; and 92%, 87%, and 77% in H group. High peritoneal permeability did not predict worse patient survival or technique failure, while age, diabetes, a lower glomerular filtration rate, and high body mass index (> or =30 kg/m(2)) were independent predictors of death.


CONCLUSIONS
This study suggests that higher peritoneal transport is not a significant independent risk factor for either mortality or death-censored technique failure. The favorable outcome for high transporters in this study may be due to improved management of volume status by the increased use of APD and the use of icodextrin-based dialysis fluid.
Yang
Xiao
X
Peritoneal Dialysis Program, Toronto General Hospital, University Health Network, and University of Toronto, Toronto, Ontario, Canada.
Fang
Wei
W
Bargman
Joanne M
JM
Oreopoulos
Dimitrios G
DG
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002463:Cell Membrane Permeability; D015331:Cohort Studies; D005260:Female; D005936:Glucans / Q000493:pharmacokinetics / Q000627:therapeutic use; D005947:Glucose / Q000493:pharmacokinetics / Q000627:therapeutic use; D015312:Hemodialysis Solutions / Q000493:pharmacokinetics*; D006801:Humans; D000077607:Icodextrin; D007676:Kidney Failure, Chronic / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D010537:Peritoneum / Q000378:metabolism*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017211:Treatment Failure
D005936:Glucans; D015312:Hemodialysis Solutions; D000077607:Icodextrin; D005947:Glucose