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A treatise on dialysis adequacy and ...

Szeto, Cheuk Chun.

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A treatise on dialysis adequacy and the longevity of Chinese peritoneal dialysis patients.

Record Type:	Language materials, printed : Monograph/item
Title/Author:	A treatise on dialysis adequacy and the longevity of Chinese peritoneal dialysis patients./
Author:	Szeto, Cheuk Chun.
Description:	209 p.
Notes:	Source: Dissertation Abstracts International, Volume: 62-09, Section: B, page: 3966.
Contained By:	Dissertation Abstracts International62-09B.
Subject:	Health Sciences, Medicine and Surgery. -
Online resource:	http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3025883
ISBN:	0493378774

A treatise on dialysis adequacy and the longevity of Chinese peritoneal dialysis patients.
Szeto, Cheuk Chun.

A treatise on dialysis adequacy and the longevity of Chinese peritoneal dialysis patients. - 209 p.

Source: Dissertation Abstracts International, Volume: 62-09, Section: B, page: 3966.

Thesis (M.D.)--Chinese University of Hong Kong (People's Republic of China), 2001.

Since the first description, continuous ambulatory peritoneal dialysis (CAPD) has gained acceptance as long-term renal replacement therapy. The “dosage” of peritoneal dialysis could be quantified by measuring small solute clearance. There is substantial evidence from observational studies that a higher dialysis dosage in Caucasians is associated with better outcome. However, most studies focused on total small solute clearance in patients with significant residual renal function. Importantly, total clearance composes of two parts: peritoneal clearance (i.e. clearance provided by dialysis) and renal clearance (i.e. residual renal function). Notably, one assumes renal and peritoneal clearances are equivalent. Nevertheless, this assumption has not been proved, and the relative importance of renal and peritoneal clearance have not been examined. In Hong Kong, CAPD is the first line renal replacement therapy. Patients are switched to hemodialysis when they have peritoneal failure. This policy provides an excellent opportunity to examine the effect of dialysis adequacy on the clinical outcome. We first examined the effect of total clearance in 270 unselected Chinese CAPD patients for 3 years. We found that Chinese CAPD patients had a low mortality. A higher total clearance was associated with better survival and fewer hospitalization. However, the effect of total clearance was confounded by renal clearance. We next tried to dissect the effect of peritoneal clearance from renal clearance. Two groups of patients with different renal clearance were followed for one year. Despite a similar total clearance, patients with higher renal clearance had fewer hospitalizations. However, total clearance, independent of renal clearance, correlated with nutritional status. We further studied the effect of peritoneal clearance in 140 anuric patients to eliminate the confounding effect of renal clearance. We found that higher peritoneal clearance was associated with better technique survival and fewer hospitalisations. From this series of work, we conclude that renal and peritoneal clearance are not equivalent. Peritoneal clearance affects the mortality and morbidity of CAPD patients. This effect is preserved in an ethnic group with low overall mortality. Our result highlights the importance of adequate dialysis in CAPD patients.

ISBN: 0493378774Subjects--Topical Terms:

1017756
Health Sciences, Medicine and Surgery.

A treatise on dialysis adequacy and the longevity of Chinese peritoneal dialysis patients.
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005 20110509
008 110509s2001 eng d
020 $a 0493378774
035 $a (UnM)AAI3025883
035 $a AAI3025883
040 $a UnM $c UnM
100 1 $a Szeto, Cheuk Chun. $3 1257874
245 1 0 $a A treatise on dialysis adequacy and the longevity of Chinese peritoneal dialysis patients.
300 $a 209 p.
500 $a Source: Dissertation Abstracts International, Volume: 62-09, Section: B, page: 3966.
500 $a Supervisor: Joseph J. Y. Sung.
502 $a Thesis (M.D.)--Chinese University of Hong Kong (People's Republic of China), 2001.
520 $a Since the first description, continuous ambulatory peritoneal dialysis (CAPD) has gained acceptance as long-term renal replacement therapy. The “dosage” of peritoneal dialysis could be quantified by measuring small solute clearance. There is substantial evidence from observational studies that a higher dialysis dosage in Caucasians is associated with better outcome. However, most studies focused on total small solute clearance in patients with significant residual renal function. Importantly, total clearance composes of two parts: peritoneal clearance (i.e. clearance provided by dialysis) and renal clearance (i.e. residual renal function). Notably, one assumes renal and peritoneal clearances are equivalent. Nevertheless, this assumption has not been proved, and the relative importance of renal and peritoneal clearance have not been examined. In Hong Kong, CAPD is the first line renal replacement therapy. Patients are switched to hemodialysis when they have peritoneal failure. This policy provides an excellent opportunity to examine the effect of dialysis adequacy on the clinical outcome. We first examined the effect of total clearance in 270 unselected Chinese CAPD patients for 3 years. We found that Chinese CAPD patients had a low mortality. A higher total clearance was associated with better survival and fewer hospitalization. However, the effect of total clearance was confounded by renal clearance. We next tried to dissect the effect of peritoneal clearance from renal clearance. Two groups of patients with different renal clearance were followed for one year. Despite a similar total clearance, patients with higher renal clearance had fewer hospitalizations. However, total clearance, independent of renal clearance, correlated with nutritional status. We further studied the effect of peritoneal clearance in 140 anuric patients to eliminate the confounding effect of renal clearance. We found that higher peritoneal clearance was associated with better technique survival and fewer hospitalisations. From this series of work, we conclude that renal and peritoneal clearance are not equivalent. Peritoneal clearance affects the mortality and morbidity of CAPD patients. This effect is preserved in an ethnic group with low overall mortality. Our result highlights the importance of adequate dialysis in CAPD patients.
590 $a School code: 1307.
650 4 $a Health Sciences, Medicine and Surgery. $3 1017756
690 $a 0564
710 2 0 $a Chinese University of Hong Kong (People's Republic of China). $3 1249360
773 0 $t Dissertation Abstracts International $g 62-09B.
790 $a 1307
790 1 0 $a Sung, Joseph J. Y., $e advisor
791 $a M.D.
792 $a 2001
856 4 0 $u http://pqdd.sinica.edu.tw/twdaoapp/servlet/advanced?query=3025883