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2015 ; 10
(11
): 1990-2001
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Peritoneal Equilibration Test and Patient Outcomes
#MMPMID26463882
Mehrotra R
; Ravel V
; Streja E
; Kuttykrishnan S
; Adams SV
; Katz R
; Molnar MZ
; Kalantar-Zadeh K
Clin J Am Soc Nephrol
2015[Nov]; 10
(11
): 1990-2001
PMID26463882
show ga
BACKGROUND AND OBJECTIVES: Although a peritoneal equilibration test yields data
on three parameters (4-hour dialysate/plasma creatinine, 4- to 0-hour dialysate
glucose, and 4-hour ultrafiltration volume), all studies have focused on the
prognostic value of dialysate/plasma creatinine for patients undergoing
peritoneal dialysis. Because dialysate 4- to 0-hour glucose and ultrafiltration
volume may be superior in predicting daily ultrafiltration, the likely mechanism
for the association of peritoneal equilibration test results with outcomes, we
hypothesized that they are superior to dialysate/plasma creatinine for risk
prediction. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We examined unadjusted
and adjusted associations of three peritoneal equilibration test parameters with
all-cause mortality, technique failure, and hospitalization rate in 10,142
patients on peritoneal dialysis treated between January 1, 2007 and December 31,
2011 in 764 dialysis facilities operated by a single large dialysis organization
in the United States, with a median follow-up period of 15.8 months; 87% were
treated with automated peritoneal dialysis. RESULTS: Demographic and clinical
parameters explained only 8% of the variability in dialysate/plasma creatinine.
There was a linear association between dialysate/plasma creatinine and mortality
(adjusted hazards ratio per 0.1 unit higher, 1.07; 95% confidence interval, 1.02
to 1.13) and hospitalization rate (adjusted incidence rate ratio per 0.1 unit
higher, 1.05; 95% confidence interval, 1.03 to 1.06). Dialysate/plasma creatinine
and dialysate glucose were highly correlated (r=-0.84) and yielded similar risk
prediction. Ultrafiltration volume was inversely related with hospitalization
rate but not with all-cause mortality. None of the parameters were associated
with technique failure. Adding 4- to 0-hour dialysate glucose, ultrafiltration
volume, or both did not result in any improvement in risk prediction with
dialysate/plasma creatinine alone. CONCLUSIONS: This analysis from a large
contemporary cohort treated primarily with automated peritoneal dialysis
validates dialysate/plasma creatinine as a robust predictor of outcomes in
patients treated with peritoneal dialysis.
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