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D Malhotra

Publications and source records attributed to D Malhotra.

76 records · Page 5Linked to original sources
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Fractional urea clearance estimates using two anthropometric formulas in continuous peritoneal dialysis: sex, height, and body composition differences.

OBJECTIVE: To compare estimates of urea volume (V) and KT/V obtained by the Watson and Hume anthropometric formulas, and to identify the similarities and differences between these estimates. DESIGN: Theoretical analysis applying wide variations in the determinants of anthropometric V (age, height, weight) in hypothetical women and men. Analysis of urea kinetic studies performed in patients on continuous peritoneal dialysis (CPD). SETTING: Four dialysis units in Albuquerque, two in Athens, and two in Thessaloniki. PARTICIPANTS: Three hundred and two CPD patients who had 440 urea kinetic studies. INTERVENTION: Standard urea clearance was performed by 24-hour collections of urine and drained dialysate followed by blood sampling. V was estimated by both the Watson and Hume formulas. MAIN OUTCOME MEASURES: Estimates of V and KT/V were compared separately in women and men by Student's t-test, linear regression, and limits of agreement (mean difference +/- 2 SD). The agreement of the KT/V estimates was also tested by the kappa ratio using a value of 1.70 weekly as the lowest acceptable K/TV. RESULTS: The theoretical analysis indicated important disagreement only in extreme variations from the ordinary in height and, to a lesser extent, weight. Differences due to height variation were pronounced only in hypothetical women. CPD patient findings were as follows: in women, Watson V and weekly KT/V were 30.4 +/- 4.4 L and 2.10 +/- 0.61, respectively. Corresponding Hume estimates were 30.3 +/- 5.4 Land 2.1 2 +/- 0.66, respectively. Corresponding estimates for men were 40.5 +/- 5.7 L and 1 .92 +/- 0.57 (Watson) plus 41.4 +/- 5.6 L and 1.88 +/- 0.57 (Hume), respectively. By linear regression, KT/V(Hume) = -0.083 + 1.052 (KT/V(Watson)), r = 0.961 (women); and KT/V(Hume) = -0.026 +/- 0.992 (KT/V(Watson)), r = 0.985 (men). Limits of agreement were -1.41 L and 2.10 L for V, and -0.15 and 0.14 weekly for KT/V. In 94.3% of the cases, KT/V(Watson) and KT/V(Hume) agreed (both > 1 .70 or both < 1 .70 weekly). Kappa ratio was 0.875 (excellent agreement). The concordant and discordant groups differed in height and degree of obesity, in agreement with the theoretical analysis. CONCLUSION: The Watson and Hume formulas provide similar estimates of V and KT/V in CPD patients. Differences may be noted only if women's height or, to a lesser extent, both sexes' weight is at a great variance with the ordinary values.

Adult↗
PubMedDate not supplied

Symptomatic ascites after discontinuation of continuous peritoneal dialysis.

OBJECTIVE: To analyze pathogenetic associations, clinical features, management, and outcome of ascites following discontinuation of continuous peritoneal dialysis (CPD). DESIGN: Retrospective analysis of symptomatic ascites, defined as ascites requiring at least one therapeutic paracentesis, developing in patients who discontinued CPD. SETTING: Dialysis unit of one tertiary care center. PARTICIPANTS: Twelve patients with 13 episodes of symptomatic ascites diagnosed soon after (a few days to 2 months) discontinuation of CPD. INTERVENTIONS: Diagnostic tests to characterize the pathogenesis of ascites; management of ascites by hemodialysis or CPD. MAIN OUTCOME MEASURES: Evolution of clinical features and nutritional parameters, survival. RESULTS: Ascites was infectious in 3 episodes (non-tuberculous mycobacterial peritonitis) and noninfectious in the remaining 10 episodes. Serum-to-ascites albumin concentration gradient (AG) was 6.3 +/- 1.5 g/L in infectious ascites and 17.3 +/- 2.7 g/L ( >11 g/L in every episode) in noninfectious ascites. Infectious ascites was managed with hemodialysis, prolonged courses of antimicrobial agents, and repeated paracentesis. Paracentesis ceased after 3-9 months. The patients were alive after 52 +/- 19 months. Seven episodes of noninfectious ascites were managed by hemodialysis and repeated paracentesis. Five patients died within 6 months from cardiac causes or sepsis. The remaining 2 patients died after 14 and 16 months from cardiac causes. Three episodes of noninfectious ascites in 2 patients were treated by restarting CPD within 2-5 months. Patients were alive at 16.9 +/- 13.2 months. They were asymptomatic and achieved fluid control. On the same CPD schedule, peritoneal clearances of urea and creatinine and normalized protein nitrogen appearance were unchanged between the initial and restarted CPD. Serum albumin was 33.3 +/- 2.5 g/L at the end of the first CPD period, 23.6 +/- 2.5 g/L soon after restarting CPD, and 31.3 +/- 5.5 g/L 4 months after restarting CPD. CONCLUSIONS: Noninfectious ascites after discontinuation of CPD is often characterized by an AG > 11 g/L, suggesting portal hypertension. Restarting CPD in noninfectious ascites may be associated with improvement in ascites symptomatology and nutritional parameters and with satisfactory survival.

Adult↗
PubMedDate not supplied

Drain volume required for a target peritoneal clearance: formulae based on peritoneal transport type and body size.

The authors developed formulae calculating the daily drain volume (DV) required for a target normalized peritoneal clearance of urea (Kt/V(ur)) or creatinine (Ccr, Kt/Vcr) in peritoneal dialysis (PD). DV depends on the target clearance, the peritoneal solute transport type, and the size of the person as expressed by body surface area (BSA) or body water (V). To illustrate the formulae, we constructed nomograms for the following weekly target clearances: Ccr = 60 L/1.73 m2, Kt/V(ur) = 2.0, Kt/Vcr = 1.8 (the value corresponding to a Ccr of 60 L/1.73 m2 in a linear regression of the two parameters in 476 clearance studies in continuous ambulatory PD [CAPD] patients). The PD schedules studied included CAPD, continuous cycling PD (CCPD) with one 2 L daytime dwell, and a combination of daytime CAPD and nighttime automated PD (APD) with 2 hr dwell times. Peritoneal transport was characterized as low, low-average, high-average, or high by the dialysate-to-plasma (D/P) creatinine concentration ratio in a peritoneal equilibration test (PET). The D/P value entered for each transport type was the appropriate 95% lower confidence limit of the mean D/P in actual studies (2 hr and 4 hr D/P from 102 PET studies and 5.5 hr D/P from 476 clearance studies in CAPD patients). For high transport, the required DV values were similar in all three PD schedules studied. For low transport, the required DV was much larger, comparatively, for CCPD and CAPD-APD than for CAPD. Furthermore, the DV values required for a weekly Kt/V(ur) of 2.0 were comparatively less than the DV values required for a weekly Kt/Vcr of 1.8 (Ccr of 60 L/1.73 M2). Calculation of the DV required for different PD schedules, a target peritoneal clearance, and the patients's size is feasible when the patient's peritoneal transport characteristics are known. This calculation also allows the selection of the least costly PD schedule. Current target values for urea and creatinine clearance are incompatible in anuric PD patients.

Biological Transport↗