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Association of Alternative Approaches to Normalizing Peritoneal Dialysis Clearance with Mortality and Technique Failure: A Retrospective Analysis Using the United States Renal Data System-Dialysis Morbidity and Mortality Study, Wave 2.
Perit Dial Int. 2017 1-2; 37(1):85-93.PD

Abstract

BACKGROUND:

Total body water (V) is an imprecise metric for normalization of dialytic urea clearance (Kt). This poses a risk of early mortality/technique failure (TF). We examined differences in the distribution of peritoneal Kt/V when V was calculated with actual weight (AW), ideal weight (IW), and adjusted weight (ADW). We also examined the associations of these Kt/V measurements, Kt/body surface area (BSA), and non-normalized Kt with mortality and TF. ♦

METHODS:

This is a retrospective cohort study of 534 incident peritoneal dialysis (PD) patients from the Dialysis Morbidity and Mortality Study Wave 2 linked with United States Renal Data System through 2010. Using Cox-proportional hazard models, we examined the relationship of several normalization strategies for peritoneal urea clearance, including Kt/VAW, Kt/VIW, Kt/VADW, Kt/BSA, and non-normalized Kt, with the outcomes of mortality and TF. Harrell's c-statistics were used to assess the relative predictive ability of clearance metrics for mortality and TF. The distributions of Kt/VAW, KT/VIW, and KT/VADW were compared within and between body mass index (BMI) strata. ♦

RESULTS:

Median patient age: 59 (54% male; 72% white; 91% continuous ambulatory PD [CAPD]). Median 24-hour urine volume: 700 mL; median estimated glomerular filtration rate (eGFR) at initiation: 7.15 mL/min/1.73 m2. Technique failure and transplant-censored mortality at 5 years: 37%. Death and transplant-censored TF at 5 years: 60%. There were no significant differences in initial eGFR and 24-hour urine volume across BMI strata. There were statistically significant differences in each Kt/V calculation within the underweight, overweight, and obese strata. After adjustment, there were no significant differences in the hazard ratios (HRs) for TF/mortality for each clearance calculation. Harrell's c-statistics for mortality for each clearance calculation were 0.78, and for TF, 0.60 - 0.61. ♦

CONCLUSIONS:

Peritoneal urea clearances are sensitive to subtle changes in the estimation of V. However, there were no detectable significant associations of Kt/VAW, Kt/VIW, Kt/VADW, Kt/BSA, or Kt with TF or mortality.

Authors+Show Affiliations

Drexel University College of Medicine, Philadelphia, PA, USA suzanne.boyle@drexelmed.edu.University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.Yale University School of Medicine, New Haven, CT, USA.University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

27680757

Citation

Boyle, Suzanne M., et al. "Association of Alternative Approaches to Normalizing Peritoneal Dialysis Clearance With Mortality and Technique Failure: a Retrospective Analysis Using the United States Renal Data System-Dialysis Morbidity and Mortality Study, Wave 2." Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, vol. 37, no. 1, 2017, pp. 85-93.
Boyle SM, Li Y, Wilson FP, et al. Association of Alternative Approaches to Normalizing Peritoneal Dialysis Clearance with Mortality and Technique Failure: A Retrospective Analysis Using the United States Renal Data System-Dialysis Morbidity and Mortality Study, Wave 2. Perit Dial Int. 2017;37(1):85-93.
Boyle, S. M., Li, Y., Wilson, F. P., Glickman, J. D., & Feldman, H. I. (2017). Association of Alternative Approaches to Normalizing Peritoneal Dialysis Clearance with Mortality and Technique Failure: A Retrospective Analysis Using the United States Renal Data System-Dialysis Morbidity and Mortality Study, Wave 2. Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis, 37(1), 85-93. https://doi.org/10.3747/pdi.2015.00227
Boyle SM, et al. Association of Alternative Approaches to Normalizing Peritoneal Dialysis Clearance With Mortality and Technique Failure: a Retrospective Analysis Using the United States Renal Data System-Dialysis Morbidity and Mortality Study, Wave 2. Perit Dial Int. 2017 1-2;37(1):85-93. PubMed PMID: 27680757.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association of Alternative Approaches to Normalizing Peritoneal Dialysis Clearance with Mortality and Technique Failure: A Retrospective Analysis Using the United States Renal Data System-Dialysis Morbidity and Mortality Study, Wave 2. AU - Boyle,Suzanne M, AU - Li,Yimei, AU - Wilson,F Perry, AU - Glickman,Joel D, AU - Feldman,Harold I, Y1 - 2016/09/28/ PY - 2015/09/10/received PY - 2016/08/03/accepted PY - 2016/9/30/pubmed PY - 2017/12/12/medline PY - 2016/9/30/entrez KW - Kt/V KW - Peritoneal dialysis KW - adjusted weight KW - ideal weight KW - mortality KW - normalizaton of urea clearance KW - technique failure KW - urea clearance SP - 85 EP - 93 JF - Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis JO - Perit Dial Int VL - 37 IS - 1 N2 - ♦ BACKGROUND: Total body water (V) is an imprecise metric for normalization of dialytic urea clearance (Kt). This poses a risk of early mortality/technique failure (TF). We examined differences in the distribution of peritoneal Kt/V when V was calculated with actual weight (AW), ideal weight (IW), and adjusted weight (ADW). We also examined the associations of these Kt/V measurements, Kt/body surface area (BSA), and non-normalized Kt with mortality and TF. ♦ METHODS: This is a retrospective cohort study of 534 incident peritoneal dialysis (PD) patients from the Dialysis Morbidity and Mortality Study Wave 2 linked with United States Renal Data System through 2010. Using Cox-proportional hazard models, we examined the relationship of several normalization strategies for peritoneal urea clearance, including Kt/VAW, Kt/VIW, Kt/VADW, Kt/BSA, and non-normalized Kt, with the outcomes of mortality and TF. Harrell's c-statistics were used to assess the relative predictive ability of clearance metrics for mortality and TF. The distributions of Kt/VAW, KT/VIW, and KT/VADW were compared within and between body mass index (BMI) strata. ♦ RESULTS: Median patient age: 59 (54% male; 72% white; 91% continuous ambulatory PD [CAPD]). Median 24-hour urine volume: 700 mL; median estimated glomerular filtration rate (eGFR) at initiation: 7.15 mL/min/1.73 m2. Technique failure and transplant-censored mortality at 5 years: 37%. Death and transplant-censored TF at 5 years: 60%. There were no significant differences in initial eGFR and 24-hour urine volume across BMI strata. There were statistically significant differences in each Kt/V calculation within the underweight, overweight, and obese strata. After adjustment, there were no significant differences in the hazard ratios (HRs) for TF/mortality for each clearance calculation. Harrell's c-statistics for mortality for each clearance calculation were 0.78, and for TF, 0.60 - 0.61. ♦ CONCLUSIONS: Peritoneal urea clearances are sensitive to subtle changes in the estimation of V. However, there were no detectable significant associations of Kt/VAW, Kt/VIW, Kt/VADW, Kt/BSA, or Kt with TF or mortality. SN - 1718-4304 UR - https://www.unboundmedicine.com/medline/citation/27680757/Association_of_Alternative_Approaches_to_Normalizing_Peritoneal_Dialysis_Clearance_with_Mortality_and_Technique_Failure:_A_Retrospective_Analysis_Using_the_United_States_Renal_Data_System_Dialysis_Morbidity_and_Mortality_Study_Wave_2_ L2 - https://journals.sagepub.com/doi/10.3747/pdi.2015.00227?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -