Peritoneal albumin and protein losses do not predict outcome in peritoneal dialysis patients.
OBJECTIVE
Peritoneal clearance of albumin-unlike the transport of small molecules-is defined by both vascular surface area and size-selective permeability. Few studies have supported a positive correlation between peritoneal albumin loss and mortality. The aim of this study was to investigate whether baseline peritoneal loss and clearance of albumin and other proteins is a risk factor of death in peritoneal dialysis patients.


METHODS
All incident peritoneal dialysis patients in our center during the last 15 years were included. Mass-transfer area coefficient of creatinine and peritoneal clearances of albumin, β₂-microglobulin, α₂-macroglobulin, and immunoglobulin G were calculated during a standard peritoneal permeability analysis. The total amount of albumin loss in the dialysate was also calculated. Overall mortality was studied with an intention-to-treat analysis.


RESULTS
Two hundred fifty-seven patients were included. High baseline albumin clearance was associated with fast transport status, the presence of peripheral arterial disease, and a high comorbidity index, whereas C-reactive protein levels did not differ from the patients with low albumin clearance. Age, high comorbidity score, C-reactive protein levels >10 mg/L, and a low serum albumin were associated with mortality. Peritoneal albumin clearances and albumin loss were not associated with death in crude and adjusted analysis. Similarly, peritoneal clearances of immunoglobulin G, α₂-macroglobulin, and β₂-microglobulin were not determinants of survival.


CONCLUSIONS
Baseline peritoneal albumin and protein clearances are associated with signs of comorbidity, but this does not have a measurable effect on patient survival.
Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands.
Olga
O
Balafa
Nynke
N
Halbesma
Dirk G
DG
Struijk
Friedo W
FW
Dekker
Raymond T
RT
Krediet
D000328:Adult; D000368:Aged; D001798:Blood Proteins / Q000378:metabolism*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D006801:Humans; D034141:Hypoalbuminemia / Q000097:blood / Q000209:etiology / Q000401:mortality; D007074:Immunoglobulin G / Q000378:metabolism; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality*; D010537:Peritoneum / Q000378:metabolism*; D010539:Permeability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012709:Serum Albumin / Q000378:metabolism*; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D000511:alpha-Macroglobulins / Q000378:metabolism; D001613:beta 2-Microglobulin / Q000378:metabolism
D001798:Blood Proteins; D007074:Immunoglobulin G; D012709:Serum Albumin; D000511:alpha-Macroglobulins; D001613:beta 2-Microglobulin