Special Report
1997 peritoneal dialysis–core indicators study: Dialysis adequacy and nutritional indicators report

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Abstract

The 1997 Peritoneal Dialysis–Core Indicators Study: Dialysis Adequacy and Nutritional Indicators Report documents the current status of peritoneal dialysis within the United States. A national random sample of adult peritoneal dialysis (PD) patients participating in the United States End Stage Renal Disease (ESRD) program was surveyed. PD subjects were large, with a mean body weight of 76 ± 18.9 kg (mean ± 1 SD) and a body mass index (BMI) of 27 ± 6.4. The dialysis prescriptions documented achieved a mean weekly Kt/Vurea (wKt/V) and weekly creatinine clearance (wCrCl) of 2.45 ± 2.29 and 65.5 ± 35.2 L/wk/1.73m2, respectively. The serum albumin of these patients was 3.5 ± 0.48 g/dL, their normalized protein equivalent of nitrogen appearance (nPNA) 1.0 ± 0.63 g/kg/d, and their normalized creatinine appearance rate (nCAR) 14 ± 6.0 mg/kg/d. Serum albumin correlated meagerly but in a positive fashion with BMI, nPNA, and nCAR, and negatively with wCrCl. Among adult US PD patients, serum albumin values appear to correlate poorly with alternative measures of nutritional status and are inversely related to the intensity of renal replacement therapy. The presumptive dietary protein intake (nPNA) and creatinine appearance rate (nCAR) derived for PD patients do correlate in a positive fashion with dialysis delivery, at least up to a wCrCl of 60 to 80 L/wk/1.73 m2 and wKt/V = 2.1, but their values suggest that 30% to 50% of PD patients have marginal nutritional status.

Section snippets

Methods

The data contained in this report are available from the Quality Measurement and Health Assessment Group, Office of Clinical Standards and Quality, Health Care Financing Administration (HCFA), US Department of Health and Human Services, 7500 Security Blvd, Baltimore, MD, and are identified as the 1997 Peritoneal Dialysis–Core Indicators Study (1997 PD-CIS). In February 1997, HCFA's Renal Beneficiary Utilization System identified a national random sample of 1,375 adult PD patients (≅5% of the

Results

Completed forms were received for 1,219 subjects (89% of the sample), 57% of whom used continuous ambulatory peritoneal dialysis (CAPD) and 39% automated peritoneal dialysis (APD) in the forms of chronic cycling peritoneal dialysis (CCPD) and PD-Plus therapy. The remaining 4% of patients used intermittent peritoneal dialysis, tidal peritoneal dialysis, or other hybrid dialysis formulae, and these patients are not included in subsequent analyses. There were few differences between the patients

Discussion

General clinical observations substantiate the premise that peritoneal dialysis alters the uremic condition. Acutely uremic individuals become more alert and vital and show improved appetite and weight gain after initiation of PD. The quantity of renal replacement therapy necessary to achieve and maintain this outcome remains incompletely defined, and estimates of a minimal desired renal replacement dose vary. The National Kidney Foundation's DOQI guidelines26 suggest that PD should provide

Conclusion

The data reported here represent a prevalence report and cannot be used to determine causality. Longitudinal follow-up would be necessary to associate patient outcome with the variables measured in this report. Similarly, assessing the effects of any intervention that changes one of the reported variables on patient welfare is not possible with this data set. The information reported here does, however, describe the status of US peritoneal dialysis patients in 1997. These patients exhibit a

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    Received December 4, 1998; accepted in revised form February 16, 1999.

    Address reprint requests to Michael J. Flanigan, MD, Department of Medicine, T-305-GH, University of Iowa Hospitals and Clinics, 200 Hawkins Dr, Iowa City, IA 52242-4060. E-mail: [email protected]

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