title: Clinical Validation of a Peritoneal Dialysis Prescription Model in the PatientOnLine Software.
abstract: Peritoneal transport characteristics and residual renal function require regular control and subsequent adjustment of the peritoneal dialysis (PD) prescription. Prescription models shall facilitate the prediction of the outcome of such adaptations for a given patient. In the present study, the prescription model implemented in the PatientOnLine software was validated in patients requiring a prescription change. This multicenter, international prospective cohort study with the aim to validate a PD prescription model included patients treated with continuous ambulatory peritoneal dialysis. Patients were examined with the peritoneal function test (PFT) to determine the outcome of their current prescription and the necessity for a prescription change. For these patients, a new prescription was modeled using the PatientOnLine software (Fresenius Medical Care, Bad Homburg, Germany). Two to four weeks after implementation of the new PD regimen, a second PFT was performed. The validation of the prescription model included 54 patients. Predicted and measured peritoneal Kt/V were 1.52 ± 0.31 and 1.66 ± 0.35, and total (peritoneal + renal) Kt/V values were 1.96 ± 0.48 and 2.06 ± 0.44, respectively. Predicted and measured peritoneal creatinine clearances were 42.9 ± 8.6 and 43.0 ± 8.8 L/1.73 m(2)/week and total creatinine clearances were 65.3 ± 26.0 and 63.3 ± 21.8 L/1.73 m(2) /week, respectively. The analysis revealed a Pearson's correlation coefficient for peritoneal Kt/V of 0.911 and Lin's concordance coefficient of 0.829. The value of both coefficients was 0.853 for peritoneal creatinine clearance. Predicted and measured daily net ultrafiltration was 0.77 ± 0.49 and 1.16 ± 0.63 L/24 h, respectively. Pearson's correlation and Lin's concordance coefficient were 0.518 and 0.402, respectively. Predicted and measured peritoneal glucose absorption was 125.8 ± 38.8 and 79.9 ± 30.7 g/24 h, respectively, and Pearson's correlation and Lin's concordance coefficient were 0.914 and 0.477, respectively. With good predictability of peritoneal Kt/V and creatinine clearance, the present model provides support for individual dialysis prescription in clinical practice. Peritoneal glucose absorption and ultrafiltration are less predictable and are likely to be influenced by additional clinical factors to be taken into consideration.
authors.affiliation: Clinic for Internal Diseases, University Clinical Center, Tuzla, Bosnia and Herzegovina.
authors.forename: Emir
authors.initials: E
authors.lastname: Hodzic
authors.affiliation: Clinical Center University, Sarajevo, Bosnia and Herzegovina.
authors.forename: Senija
authors.initials: S
authors.lastname: Rasic
authors.affiliation: Dr. Carol Davila Hospital, Bucharest, Romania.
authors.forename: Christian
authors.initials: C
authors.lastname: Klein
authors.affiliation: University of Medicine "Grigore T Popa", Iasi, Romania.|"C. I. Parhon" University Hospital, Iasi, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Covic
authors.affiliation: Sisli Etfal Hospital, Istanbul, Turkey.
authors.forename: Abdulkadir
authors.initials: A
authors.lastname: Unsal
authors.affiliation: General Hospital, Jaen, Spain.
authors.forename: José Manuel Gil
authors.initials: JM
authors.lastname: Cunquero
authors.affiliation: Klinikum Wels-Grieskirchen, Wels, Austria.
authors.forename: Friedrich C
authors.initials: FC
authors.lastname: Prischl
authors.affiliation: Fresenius Medical Care, Bad Homburg, Germany.
authors.forename: Adelheid
authors.initials: A
authors.lastname: Gauly
authors.affiliation: University Hospital, Bern, Switzerland.|University of Bern, Bern, Switzerland.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Kalicki
authors.affiliation: University Hospital, Bern, Switzerland.|University of Bern, Bern, Switzerland.
authors.forename: Dominik E
authors.initials: DE
authors.lastname: Uehlinger
mesh_terms: D000328:Adult; D000368:Aged; D003198:Computer Simulation; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005947:Glucose / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010530:Peritoneal Dialysis / Q000379:methods*; D010537:Peritoneum / Q000378:metabolism*; D012984:Software; D014462:Ultrafiltration; D014508:Urea / Q000378:metabolism
chemical_list: D014508:Urea; D003404:Creatinine; D005947:Glucose
keywords: Glucose modeling; Peritoneal dialysis; Prescription modeling; Small solute clearance; Ultrafiltration