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 -