Retrospective evaluation of renal kt/V(urea) at the initiation of long-term peritoneal dialysis at the University of Missouri: relationships to longitudinal nutritional status on peritoneal dialysis

Madhukar Misra, Karl D Nolph, Ramesh Khanna, Barbara F Prowant, Harold L Moore
ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs 2003, 49 (1): 91-102
The purpose of this study was to examine the impact of low levels of residual renal function (RRF) on nutritional status in end-stage renal disease patients starting peritoneal dialysis (PD) at baseline and after a year on dialysis. We conducted a single center retrospective analysis of 116 patients who started long-term PD in a university teaching hospital from 1989 to 1998 and were followed for 1 year. Patients were divided into four equal groups according to their initial renal Kt/V(urea) (L/week) levels at the start of PD and followed for 1 year. There were no interventions. The relationship between dialysis adequacy (renal and total Kt/V(urea)) and nutritional status was studied at baseline and at 1 year. Baseline data for patients who survived were compared with the baseline data of those who died and with their own 1 year data. At baseline, the mean serum albumin (3.31 g/dl, p < 0.0001) and lean body mass (47.20% body weight, p < 0.04) of group 1 were significantly lower than in groups 2, 3, and 4. Levels of normalized protein equivalent of nitrogen appearance (nPNA) were significantly lower in group 1 than in groups 3 and 4 (p < 0.005). Although group 1 patients showed trends toward improvement in nutritional parameters, they never caught up with the other groups. At the end of 1 year, the lower total Kt/V(urea) in group 1, with the lowest RRF, was associated with the lowest mean values for nutritional status and the highest death rate. Comparison of baseline and 1 year data of survivors showed that nutritional status improved or remained stable in groups 3 and 4, who exceeded the minimum recommended adequacy targets as per Dialysis Outcome Quality Initiative criteria (mean 12 month total Kt/V(urea) 2.18 and 2.58, respectively). Comparison of baseline data of survivors and those who died showed that patients who died had lower mean values for serum albumin, nPNA, lean body mass, and body weight across all groups. Low RRF at the start of dialysis is associated with poor nutritional status. Also, patients who start dialysis with low RRF and poor nutritional status do not have significantly improved nutritional status even after 1 year on dialysis.

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