title: Peritoneal protein clearance and not peritoneal membrane transport status predicts survival in a contemporary cohort of peritoneal dialysis patients.
abstract: OBJECTIVE
  Fast peritoneal membrane transport status may be due to inflammation or increased peritoneal membrane surface area. We evaluated the ability of peritoneal protein clearance (Pcl) to distinguish fast peritoneal membrane transport status as a consequence of peritoneal membrane inflammation and assess its impact on patient survival.
  
  
  METHODS
  Patients who initiated peritoneal dialysis at our center since January 1998 and had a baseline peritoneal equilibration test, measurement of dialysis adequacy, and 24-h dialysate Pcl were included. Demography, comorbidities, and biochemical data were prospectively collected. Follow-up was until death or the end of the period studied. Multivariate regression analysis identified factors that were associated with Pcl. A Cox proportional hazards model was used to identify factors that were associated with survival.
  
  
  RESULTS
  A total of 192 patients (56% men, mean age 54.3 +/- 15.3; 32% with diabetes) were included. On univariate analysis, Pcl was negatively correlated with serum albumin and positively correlated with age, dialysate/plasma creatinine ratio (D/Pcr), the presence of peripheral vascular disease, and urine volume. On multivariate analysis, serum albumin, D/Pcr, urine volume, and peripheral vascular disease remained significant. Predictors of mortality were age, comorbidity grade, and Pcl but not D/Pcr.
  
  
  CONCLUSIONS
  In this cohort, peritoneal transport status no longer predicted survival, whereas Pcl remained a predictor. Increased large-pore protein loss may reflect the severity of underlying cardiovascular disease, portending a poor prognosis for these patients.
authors.affiliation: Division of Nephrology, University Health Network and St. Michael's Hospital, University of Toronto, Canada.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Perl
authors.forename: Kit
authors.initials: K
authors.lastname: Huckvale
authors.forename: Michelle
authors.initials: M
authors.lastname: Chellar
authors.forename: Biju
authors.initials: B
authors.lastname: John
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Davies
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000401:mortality* / Q000628:therapy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010530:Peritoneal Dialysis / Q000379:methods / Q000401:mortality*; D010537:Peritoneum / Q000378:metabolism*; D010538:Peritonitis / Q000378:metabolism / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011506:Proteins / Q000378:metabolism
chemical_list: D011506:Proteins