title: Daily peritoneal ultrafiltration predicts patient and technique survival in anuric peritoneal dialysis patients.
abstract: BACKGROUND
  Maintenance dialysis therapy is the only way to remove excess fluid in patients with anuric end-stage renal disease. The optimal ultrafiltration (UF) volume in patients on peritoneal dialysis (PD) remains controversial.
  
  
  METHODS
  We retrospectively analysed a cohort of 86 prevalent anuric PD patients followed up for a median of 25.3 months (range, 6 to 54 months). Clinical and PD parameters were recorded yearly. Kaplan-Meier analysis and Cox proportional hazards models were used to identify risk factors of mortality and technique failure in patients with a UF >/=1 L/24 h or <1 L/24 h.
  
  
  RESULTS
  When compared to those with a UF <1 L/24 h, patients with a UF >/=1 L/24 h had significantly higher haemoglobin levels (101.9 +/- 20.5 vs 89.3 +/- 20.2 g/L, P < 0.05) and tended to be younger (55.0 +/- 12.5 vs 60.6 +/- 16.1 years, P = 0.10). Also, while Kt/V and CCr were stable over time, UF decreased significantly over the study period (baseline, 1205.5 +/- 327.3 ml/24 h vs after 3 years, 870.6 +/- 439.8 ml/24 h; P < 0.001). Using Kaplan-Meier analysis, patients with baseline UF <1 L/24 h had significantly worse outcome (survival, 27.2 +/- 3.9 vs 42.4 +/- 1.9 months; P < 0.001). In multivariate Cox regression analysis, age, time-dependent UF volume and serum albumin were independent predictors of mortality, while UF independently predicted technique failure.
  
  
  CONCLUSIONS
  The present study demonstrates a strong predictive value of daily peritoneal UF for both technique and patient survival in prevalent anuric PD patients. Identifying markers of satisfactory fluid status, as well as optimizing therapy to meet UF goals, remains an important clinical target.
authors.affiliation: Renal Division, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Center for Peritoneal Dialysis Research, Shanghai, China.
authors.forename: Xinghui
authors.initials: X
authors.lastname: Lin
authors.forename: Aiwu
authors.initials: A
authors.lastname: Lin
authors.forename: Zhaohui
authors.initials: Z
authors.lastname: Ni
authors.forename: Qiang
authors.initials: Q
authors.lastname: Yao
authors.forename: Weiming
authors.initials: W
authors.lastname: Zhang
authors.forename: Yucheng
authors.initials: Y
authors.lastname: Yan
authors.forename: Wei
authors.initials: W
authors.lastname: Fang
authors.forename: Aiping
authors.initials: A
authors.lastname: Gu
authors.forename: Jonas
authors.initials: J
authors.lastname: Axelsson
authors.forename: Jiaqi
authors.initials: J
authors.lastname: Qian
mesh_terms: D000328:Adult; D000368:Aged; D001002:Anuria / Q000378:metabolism / Q000401:mortality* / Q000628:therapy*; D002681:China; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000378:metabolism / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods*; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism; D016896:Treatment Outcome; D014462:Ultrafiltration / Q000379:methods*
chemical_list: D012709:Serum Albumin