Dialysis adequacy indices and body composition in male and female patients on peritoneal dialysis.
OBJECTIVE
Creatinine clearance scaled to body surface area (BSA) and urea KT/V normalized to total body water (TBW) are used as indices for peritoneal dialysis (PD) adequacy. We investigated relationships of indices of dialysis adequacy (including KT/V, KT, clearance, dialysate over plasma concentration ratio) and anthropometric and body composition parameters (BSA, TBW, body mass index (BMI), weight, height, fat mass (FM), and fat-free mass (FFM)) in male and female patients on continuous ambulatory peritoneal dialysis.


METHODS
Ninety-nine stable patients (56 males) performed four 24-hr collections of drained dialysate for four dialysis schedules with three daily exchanges of glucose 1.36% and one night exchange of either: 1) glucose 1.36%, 2) glucose 2.27%, 3) glucose 3.86% or 4) icodextrin 7.5%.


RESULTS
KT and dialysate over plasma concentration ratio, CD/CP, for urea and creatinine were similar for males and females and, in general, did not depend on body-size parameters including V (= TBW), which means that the overall capacity of the transport system in females and males is similar. However, after normalization of KT to V or 1.73/BSA yielding KT/V and creatinine clearance, Cl(1.73/BSA), respectively, the normalized indices were substantially higher in females than in males and correlated inversely with body-size parameters, especially in males.


CONCLUSIONS
As KT/V depends strongly on body size, treatment target values for KT/V should take body size and therefore also gender into account. As KT is less influenced by body size, body composition and gender, KT should be considered as a potential auxiliary index in PD.
Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
Malgorzata
M
Debowska
Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
Ramón
R
Paniagua
Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
María-de-Jesús
MD
Ventura
Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
Marcela
M
Ávila-Díaz
Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
Carmen
C
Prado-Uribe
Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
Carmen
C
Mora
Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
Elvia
E
García-López
Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
Abdul Rashid
AR
Qureshi
Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
Bengt
B
Lindholm
Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Department for Mathematical Modelling of Physiological Processes, Warsaw, Poland; Unidad de Investigacion Medica en Enfermedades Nefrologicas, Hospital de Especialidades, Centro Medico Nacional Siglo XXI, Mexico City, Mexico; and Karolinska Institutet, Divisions of Baxter Novum and Renal Medicine, Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
Jacek
J
Waniewski
D000328:Adult; D000368:Aged; D000886:Anthropometry; D001692:Biological Transport; D001823:Body Composition / Q000502:physiology*; D003404:Creatinine / Q000097:blood; D015314:Dialysis Solutions / Q000378:metabolism*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D007677:Kidney Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D012737:Sex Factors
D015314:Dialysis Solutions; D003404:Creatinine
KT/V; Peritoneal dialysis adequacy; body composition; clearance; creatinine; gender; urea