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International Journal of Nephrology
Volume 2011 (2011), Article ID 685457, 6 pages
http://dx.doi.org/10.4061/2011/685457
Clinical Study

Previous Renal Replacement Therapy Time at Start of Peritoneal Dialysis Independently Impact on Peritoneal Membrane Ultrafiltration Failure

1Nephrology Department, CHP-Hospital Santo António, 4000 Porto, Portugal
2Investigation Unit UMIB/UP, Abel Salazar Biomedical Sciences Institute, 4099-003 Porto, Portugal

Received 28 February 2011; Revised 5 July 2011; Accepted 8 August 2011

Academic Editor: Olof Heimburger

Copyright © 2011 Luís Oliveira and Anabela Rodrigues. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Peritoneal membrane changes are induced by uraemia per se. We hypothesise that previous renal replacement therapy (RRT) time and residual renal function (RRF) at start of peritoneal dialysis impact on ultrafiltration failure (UFF). Methods. The time course of PET parameters from 123 incident patients, followed for median 26 (4–105) months, was evaluated by mixed linear model. Glucose 3.86% solutions were not used in their standard therapy. Sex, age, diabetes, previous RRT time, RRF, comorbidity score, PD modality and peritonitis episodes were investigated as possible determinants of UFF-free survival. Results. PET parameters remained stable during follow up. CA125 decreased significantly. Inherent UFF was diagnosed in 8 patients, 5 spontaneously recovering. Acquired UFF group presented type I UFF profile with compromised sodium sieving. At baseline they had lower RRF and longer previous time of RRT which remained significantly associated with UFF-free survival by Cox multivariate analysis (HR 0.648 (0.428–0.980), ) and (HR 1.016 (1.004–1.028), , resp.). UFF free survival was 97%, 87% and 83% at 1, 3 and 5 years, respectively. Conclusions. Inherent UFF is often unpredictable but transitory. On the other hand baseline lower RRF and previous RRT time independently impact on ultrafiltration failure free survival. In spite of these detrimental factors generally stable long-term peritoneal transport parameters is achievable with a 5-year cumulative UFF free survival of 83%. This study adds a further argument for a PD-first policy.