Estimating total small solute clearance in patients treated with continuous ambulatory peritoneal dialysis without urine and dialysate collection

Li Fan, Dominik Steubl, Lesley A. Inker, Hocine Tighiouart, Andrew L. Simon, Meredith C. Foster, Amy B. Karger, John H. Eckfeldt, Hongyan Li, Jiamin Tang, Yongcheng He, Minyan Xie, Fei Xiong, Hongbo Li, Hao Zhang, Jing Hu, Yunhua Liao, Xudong Ye, Tariq Shafi, Wei ChenXueqing Yu, Andrew S. Levey

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Background: International Society for Peritoneal Dialysis guidelines recommend to routinely monitor the total measured clearance (mCl) of small solutes such as creatinine; however, collection of 24-h urine and peritoneal dialysis (PD) fluid is burdensome to patients and prone to errors. We hypothesized that equations could be developed to estimate mCl (estimated clearance (eCl)) using endogenous filtration markers. Methods: In the Guangzhou PD Study (n = 980), we developed eCl equations using linear regression in two-third and validated them in the remaining one-third. Reference tests were mCl for urea nitrogen (UN) (mClUN, ml/min) and average mCl for UN and creatinine (mClUN-cr, ml/min/1.73 m2). Index tests were various eCl equations using UN, creatinine, low-molecular-weight proteins (LMWPs) (beta-trace protein (BTP), beta-2 microglobulin (B2M), and cystatin C), demographic variables, and body size. After reexpression of the equations in the combined data set, we analyzed accuracy (eCl within ± 2.0 units of mCl) and the predictive value of eCl to detect a weekly total standard Kt/V (weekly mClUN indexed for total body water) > 1.7 using receiver operating characteristic curve. Results: Mean age of the cohort was 50 ± 15 years, 53% were male; mClUN was 6.9 ± 1.8 and mClUN-cr was 7.5 ± 2.8. Creatinine but not UN contributed to eCl for both mCl. LMWP did not improve accuracy for mClUN (range 88–89%). BTP and B2M improved the accuracy for mClUN-cr (82% vs. 80%); however, differences were small. The area under the curve for predicting a weekly Kt/V > 1.7 was similar for all equations (range 0.79–0.80). Conclusions: Total small solute clearance can be estimated moderately well in continuous ambulatory PD patients using serum creatinine and demographic variables without urine and dialysate collection.

Original languageEnglish (US)
Pages (from-to)84-92
Number of pages9
JournalPeritoneal Dialysis International
Volume40
Issue number1
DOIs
StatePublished - Jan 1 2020

Bibliographical note

Funding Information:
We express our appreciation to the nurses in peritoneal dialysis (PD) center of the First Affiliated Hospital, Sun Yat-sen University, who collected demographic and clinical characteristics and follow-up data for patients, as well as all patients enrolled in the Guangzhou PD Study. Declaration of conflicting interests The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: JHE was a consultant for Gentian AS until 12/2017, LAI receives grant support from Retrophin, Reata and Omeros Corporation, and WMM received payment for a peritoneal dialysis advisory council 06/2018. The remaining authors do not have any conflicts to disclose. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the Operational Grant of Guangdong Provincial Key Laboratory (2017B030314019); the Key Laboratory of Nephrology, Guangdong Province, Guangzhou, China (2002B60118); the National Kidney Foundation Key Laboratory of Nephrology, Paul Teschan Research Fund—Dialysis Clinic Inc. (“Monitoring peritoneal dialysis (PD) Adequacy Using Serum Levels of Endogenous Filtration Marker”); and Siemens Healthcare (“Monitoring PD Adequacy Using Serum Levels of Endogenous Filtration Marker”). Supplemental material Supplemental material for this article is available online.

Funding Information:
We express our appreciation to the nurses in peritoneal dialysis (PD) center of the First Affiliated Hospital, Sun Yat-sen University, who collected demographic and clinical characteristics and follow-up data for patients, as well as all patients enrolled in the Guangzhou PD Study. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by the Operational Grant of Guangdong Provincial Key Laboratory (2017B030314019); the Key Laboratory of Nephrology, Guangdong Province, Guangzhou, China (2002B60118); the National Kidney Foundation Key Laboratory of Nephrology, Paul Teschan Research Fund?Dialysis Clinic Inc. (?Monitoring peritoneal dialysis (PD) Adequacy Using Serum Levels of Endogenous Filtration Marker?); and Siemens Healthcare (?Monitoring PD Adequacy Using Serum Levels of Endogenous Filtration Marker?).

Publisher Copyright:
© The Author(s) 2020.

Keywords

  • Creatinine
  • low-molecular-weight proteins
  • peritoneal dialysis
  • residual kidney function

Fingerprint

Dive into the research topics of 'Estimating total small solute clearance in patients treated with continuous ambulatory peritoneal dialysis without urine and dialysate collection'. Together they form a unique fingerprint.

Cite this