PubMed Health⌕ Search

Biomedical subjects

L Fried

Publications and source records attributed to L Fried.

42 records · Page 3Linked to original sources
PubMedDate not supplied

Peritoneal dialysis clearance can replace residual renal function.

OBJECTIVE: There is controversy whether increasing peritoneal clearance effectively substitutes for declining residual renal function. We studied the impact of renal and peritoneal clearances on outcome, controlling for comorbidity. DESIGN: Registry database. SETTINGS: Four dialysis centers. PATIENTS: Incident peritoneal dialysis patients. METHODS: Data were collected prospectively on 90 incident patients between 1991 and 1999. At the end of their first year on peritoneal dialysis, patients were divided into groups based on the first year's clearance results: group 1 (n = 62) had weekly Kt/W greater than or equal to 2.0 and creatinine clearance (CCr/1.73 m2) greater than or equal to 60 L throughout the first year; group 2 (n = 28) fell below these targets due to loss of residual renal function and then reached targets due to prescription change. MAIN OUTCOME MEASURES: Patient and technique survival. RESULTS: Both groups were similar in baseline characteristics except age (57 years vs 49 years, p = 0.02) and initial albumin (34.4 g/L vs 37.5 g/L, p = 0.001). One-year patient survival after grouping was similar in both groups (86.3% vs 80.9%, p = 0.72). Cox proportional hazard model, controlling for comorbidity, did not show "group" to be a significant predictor of outcome (p = 0.96). One-year technique survival after grouping was similar in both groups (77.3% vs 83.2%, log rank p = 0.89). For technique failure, Cox proportional hazard model showed peritonitis (p = 0.004) to be the only significant predictor of worse outcome. CONCLUSIONS: Peritoneal dialysis patients with improved clearances due to prescription changes had survival comparable to patients who never fell below target. This suggests that loss of residual renal function may be replaced by increasing peritoneal dialysis clearance. A large multicenter trial to study this important question further is needed.

Female↗
PubMedDate not supplied

The influence of demographic factors and modality on loss of residual renal function in incident peritoneal dialysis patients.

OBJECTIVE: To determine whether gender, race, diabetes, peritoneal dialysis (PD) modality, and comorbid conditions influence loss of residual renal function (RRF). DESIGN: Retrospective study of incident PD patients, using database of prospectively collected demographic, laboratory, and clearance data. SETTING: Peritoneal Dialysis Registry of the University of Pittsburgh Medical Center. PATIENTS: The study included 184 continuous ambulatory PD and automated PD patients who had at least two 24-hour urine collections for glomerular filtration rate (GRF) between April 1991 and March 2000. 836 urine collections were analyzed. OUTCOME MEASURES: Loss of RRF was defined as the slope of the decline in GFR as measured by the average of creatinine and urea clearances in 24-hour urine collections. Stepwise forward regression was used to identify demographic and laboratory factors associated with loss of GFR. Spearman correlations were used to assess the significance of associations. RESULTS: The median rate of decline of renal function was -0.17 mL/minute/month. Gender, race, diabetes, automated PD, peritoneal equilibration test, protein equivalent of nonprotein nitrogen appearance normalized to body surface area, and serum albumin did not predict loss of RRF. Cardiac disease was the only variable affecting decline of RRF (p = 0.045). CONCLUSION: Modality of PD and patient demographic factors do not contribute to the rate at which RRF is lost in incident PD patients. Additional study of the factors contributing to the decline and maintenance of RRF is needed.

Adult↗
PubMedDate not supplied

Neither size nor weight predicts survival in peritoneal dialysis patients.

OBJECTIVE: To determine if patient size or weight at the start of PD influences patient or technique survival. DESIGN: A prospective cohort study of adult PD patients. SETTING: A university and a Veterans Administration outpatient dialysis unit. PATIENTS: 343 adults patients with 660 years on PD enrolled from 1979 to 1995. MAIN OUTCOME MEASURES: Patient survival (censoring for transplant, 60 days post-transfer to hemodialysis, and end of study) and technique survival (censoring for death, transplant, or end of the study) for patients as grouped by weight (< or = 64 kg vs. > 64 kg or < or = 82.7 kg vs. > 82.7 kg) or BSA (< or = 2.0 m2 vs > 2.0 m2). RESULTS: Patient survival was 86.3% at one year, 77.0% at two years, 65.2% at three years, and 56.9% at 4 years. Technique survival was 84.9% at one year, 77.5% at two years, 63.5% at three years, and 58.3% at four years. The patient and technique survival curves were not significantly different for patients as grouped by weight or BSA. Using Cox proportional hazards model, age, diabetes, peritonitis rate, and albumin at the start of PD were independent predictors of patient survival, but BSA and weight were not. The only predictor of technique survival was the peritonitis rate. Larger patients had higher initial albumins, which may indicate better nutritional status that may offset the risk of underdialysis. CONCLUSIONS: Large patients do as well as smaller patients on PD. Size alone should not preclude patients from PD.

Adult↗