What Is the Best Predictor of Mortality for PD Patients?

August 14, 2001 - Here is another article from this month's issue of Kidney International that shows that atrial natriuretic peptide (ANP) significantly increases peritoneal fluid removal and small solute clearances.

Here is the abstract of "Intraperitoneal atrial natriuretic peptide increases peritoneal fluid and solute removal" from Kidney International.

August 11, 2001 - An article in this month's issue of Kidney International suggests that sodium and fluid removal is a predictor of mortality in peritoneal dialysis (PD) patients, whereas urea clearances (Kt/V) and total creatinine clearance (TCC) are not factors.

This is extremely interesting in light of a study presented during the IX Congress of the International Society for Peritoneal Dialysis in June. This study was conducted in Mexico and examined peritoneal dialysis adequacy. The study found no difference in outcomes between PD patients dialyzing 45 liters per week vs. 56 liters per week. Based on this data, some were suggesting that peritoneal dialysis might have far broader applicability than current practice patterns suggest.

Regarding fluid removal during peritoneal dialysis, the Cardiovascular and Renal Drugs Advisory Committee to the U.S. Food and Drug Administration (FDA) this week unanimously recommended approval of Baxter's new peritoneal dialysis solution Extraneal (7.5% icodextrin). Baxter is seeking FDA approval for this new PD solution, which increases ultrafiltration during the long dwell dialysis exchange. (link is no longer available)

Here is the abstract of an article from the current issue of Seminars in Dialysis entitled, "Past, present, and future of quantified peritoneal dialysis".

Up to now, nearly everyone has focused on urea and creatinine clearances for PD patients. Here are the current K/DOQI� guidelines for "Adequate Dose of Peritoneal Dialysis". Here is the complete table of contents for the K/DOQI Clinical Practice Guidelines for Peritoneal Dialysis Adequacy.

According to the United States Renal Disease System (USRDS) 2001 Report, as of December 31, 1999:

• There are a decreasing number of CAPD patients. The number of CAPD patients dropped from 15,072 in 1998 to 13,406 in 1999. CAPD patients make up 5.5 percent of the dialysis patient population. This has dropped steadily since 1990, when 12.5 percent of patients were on CAPD.
  
  
• There are a decreasing number of CCPD patients. The number of CCPD patients dropped from 9772 in 1998 to 9178 in 1999. 3.8 percent of dialysis patients are on CCPD.

[This message has been edited by Gary Peterson (edited 12-11-2001).]