Search PubMed⌕ Search

Biomedical subjects

Fredric O Finkelstein

Publications and source records attributed to Fredric O Finkelstein.

At least 19 recordsLinked to original sources
PubMed2006

The initiation of peritoneal dialysis: planning the initial prescription.

The initiation of peritoneal dialysis (PD) requires that the nephrologist address certain key issues. These include patient selection for PD, the timing of the placement of the PD catheter, the timing of the initiation of PD, the schedule of PD to be utilized, and the initial regimen of PD to be prescribed. In addressing these issues, the nephrologist needs to consider not only the medical condition of the patient but also the psychosocial status and quality of life concerns of the patient and his/her family. Furthermore, the dialysis treatment regimen needs to be organized to maintain the long term viability of PD therapy.

Humans↗
PubMed2006

The role of chronic peritoneal dialysis in the management of the patient with chronic kidney disease.

The role of chronic peritoneal dialysis (CPD) in the management of patient with chronic kidney disease is being reexamined. There has been a decline in CPD utilization in the United States, which has been attributed to a variety of factors. It is important that these factors be understood and addressed, since nephrologists feel that about 30% of end-stage renal disease patients should be maintained on CPD and patients are more satisfied with CPD and feel that CPD has a less negative impact on their lives than hemodialysis. The present chapter discusses some of the reasons for decline in CPD utilization in the United States.

Chronic Disease↗
PubMed2005

Quality of life in chronic kidney disease (CKD): a cross-sectional analysis in the Renal Research Institute-CKD study.

BACKGROUND: Health-related quality of life (QOL) is an important measure of how disease affects patients' lives. Dialysis patients have decreased QOL relative to healthy controls. Little is known about QOL in patients with chronic kidney disease (CKD) before renal replacement therapy. METHODS: The Medical Outcomes Study Short Form-36 (SF-36), a standard QOL instrument, was used to evaluate 634 patients (mean glomerular filtration rate [GFR], 23.6 +/- 9.6 mL/min/1.73 m2 [0.39 +/- 0.16 mL/s/1.73 m2]) enrolled in a 4-center, prospective, observational study of CKD. SF-36 scores in these patients were compared with those in a prevalent cohort of hemodialysis (HD) patients and healthy controls (both from historical data). QOL data also were analyzed for correlations with GFR and albumin and hemoglobin levels in multivariable analyses. RESULTS: Patients with CKD had higher SF-36 scores than a large cohort of HD patients (P < 0.0001 for 8 scales and 2 summary scales), but lower scores than those reported for the US adult population (P < 0.0001 for 7 of 8 scales and 1 of 2 summary scales). Patients with CKD stage 4 had lower QOL scores than patients with CKD stage 5, although differences were not significant. Hemoglobin level was associated positively with higher mental and physical QOL scores (P < 0.05) in all individual and component scales except Pain. CONCLUSION: SF-36 scores were higher in this CKD cohort compared with HD patients, but lower than in healthy controls. GFR was not significantly associated with QOL. Hemoglobin level predicted both physical and mental domains of the SF-36. Longitudinal studies are needed to define at-risk periods for decreases in QOL during progression of CKD.

Black or African American↗
PubMed2005

Outcome of patients on chronic peritoneal dialysis undergoing peritoneal catheter removal because of peritonitis.

Peritoneal catheter removal may be clinically indicated in the management of peritonitis. The data on the course of patients undergoing peritoneal catheter reinsertion after removal for peritonitis are limited. The present study was designed to examine what happens to patients on chronic peritoneal dialysis (CPD) after peritoneal catheter removal for peritonitis. We retrospectively reviewed the charts of patients who developed peritonitis between January 1, 1990, and September 1, 2002. We identified 1146 episodes of peritonitis; in 189 of the episodes (16%), the peritoneal catheter was removed. Catheters were reinserted in 88 of those patients (47%). Reasons for peritoneal catheter removal among the 88 patients who underwent peritoneal catheter reinsertion included unit protocol (51%), poor response to antibiotics (46%), and exit-site or tunnel infection (3%). Reasons for peritoneal catheter removal among the 101 patients in whom the peritoneal catheter was not reinserted included unit protocol (62%), poor response to antibiotics (20%), and extensive history of peritonitis (18%). After reinsertion, the new peritoneal catheter remained in place for a mean of 15.4 +/- 15.4 months (range: 1-75 months). In 37 of the 88 patients with reinserted peritoneal catheters (42%), the catheters remained in place for longer than 1 year. The remaining 6 patients underwent transplantation or were transferred to another facility. Of the remaining 51 patients whose new peritoneal catheters lastedfor less than I year, 13 (25.5%) died, and 32 (63%) were transferred permanently to hemodialysis. Of the 101 patients who did not have a peritoneal catheter reinserted, 23 (23%) died within the 2-week period following the onset of peritonitis. The rest were transferred to hemodialysis. The reasons noted for not reinserting the peritoneal catheter included frequent episodes of peritonitis, patient unwillingness to retry CPD therapy, psychosocial reasons, bowel perforation, or transfer to an institution unable to perform CPD therapy. We conclude that, among patients who medically require peritoneal catheter removal because of peritonitis, few will successfully return to long-term CPD therapy. Of the patients who required peritoneal catheter removal in our study, 23% died within the first 2 weeks after the onset of peritonitis, before catheter reinsertion could be considered. Only 47% of the patients underwent a successful catheter reinsertion; and, of those, only 34% remained on CPD therapy I year later Thus, only 20% of patients undergoing PD catheter removal remain on CPD therapy 1 year after catheter removal.

Anti-Bacterial Agents↗
PubMed2004

A one-year trial of in-center daily hemodialysis with an emphasis on quality of life.

BACKGROUND/AIMS: Hemodialysis is associated with acute changes in several physiologic factors. Previous studies have suggested significant clinical and quality of life (QOL) benefits of daily hemodialysis (DHD) compared with 3 times weekly hemodialysis (CHD). We conducted a prospective trial to evaluate the effects of switching chronic hemodialysis patients to in-center DHD for a 12-month period. METHODS: There were no exclusion criteria. Patients received hemodialysis 6 times per week. The study set a standardized weekly Kt/V (stdKt/V) goal of 3.0. A broad array of clinical parameters was determined. QOL was assessed with multiple instruments. RESULTS: Eleven subjects completed 12 months and 12 completed 6 months on DHD. Significant changes relative to baseline at 12 months of DHD included decreased BP and improvements in QOL parameters by multiple techniques. 100% of patients at 12 months wished to continue DHD. CONCLUSIONS: DHD offers advantages over CHD with respect to improved QOL and BP control.

Adult↗
PubMed2004

Compliance with the dialysis regimen in chronic peritoneal dialysis patients: utility of the pro card and impact of patient education.

Noncompliance (NC) with the dialysis prescription has been described as a common problem in dialysis patients. In previous studies, NC in peritoneal dialysis (PD) patients has been assessed by obtaining patient or family histories, using questionnaires, and making home visits. With the use of the HomeChoice Pro Chip Card (PCC: Baxter Healthcare Corporation, Deerfield, IL, U.S.A.), the dialysis staff can monitor the total volume of dialysate used, the frequency of exchanges, and the duration of dialysis in patients maintained on automated peritoneal dialysis (APD). Last year, we reported that the PCC was an effective tool for assessing compliance and noted that more than half of patients had a compliance rate (CR) < 95%. In the present study, we examined the impact of patient education on compliance with the prescribed dialysis regimen. We evaluated our APD patients for CR with their dialysis prescription. The PCC was used to record the duration of dialysis and the actual volume of fluid used. From October 2002 to September 2003, all patients maintained at home for 3 consecutive months on APD in the New Haven continuous ambulatory peritoneal dialysis unit were educated concerning the importance of compliance with their dialysis regimen. They were also educated about the function of the PCC and were informed that the dialysis facility would be monitoring their compliance with the prescribed regimen. Compliance rates were calculated by dividing the delivered dialysis volume by the prescribed dialysis volume and multiplying by 100. We obtained data on 42 APD patients. Of the 42 patients, 35 (83%) had a CR > or = 95%, 3 (7%) had a CR between 90% and 94.9%, and 4 (10%) had a CR < 90%. Those CRs are much better than the ones we had previously reported, before the institution of the patient education program. The PCC can be used to assess compliance in APD patients. Patient education results in an improvement in patient compliance. Further study is required to determine factors that affect CR in APD patients.

Female↗
PubMed2003

Depression and its association with peritonitis in long-term peritoneal dialysis patients.

BACKGROUND: Depression is the most common psychological disorder among patients with end-stage renal disease and has been associated with mortality in patients maintained on hemodialysis therapy. Peritonitis is the leading cause of technique failure among long-term peritoneal dialysis (PD) patients. This prospective study is designed to examine the relationship between depression and peritonitis. METHODS: All patients on long-term PD therapy in our unit between January 1, 1997, and January 31, 2002, completed a Beck Depression Inventory (BDI) assessment at 6-month intervals. BDI scores were analyzed 2 ways. First, patients were placed into either group I (BDI score < 10) or group II (BDI score > or = 11) and were reclassified based on subsequent scores. Second, multivariable analysis was performed looking at initial BDI score as a risk factor for peritonitis, adjusting for age older than 65 years, diabetes, coronary artery disease, and race. RESULTS: One hundred sixty-two patients were enrolled, and 281 individual BDI assessments were completed. There was a significantly greater incidence of diabetes and coronary artery disease in group II. Rates for overall and gram-positive peritonitis were significantly greater in group II patients compared with group I patients. Using Cox regression, only BDI score of 11 or greater was associated with the development of peritonitis (hazard ratio, 2.7; 95% confidence interval, 1.2 to 6.0). CONCLUSION: There is an association between BDI score of 11 or greater and the development of peritonitis. Whether treatment of depression can impact on the rate of peritonitis remains to be examined.

Aged↗
PubMed2002

Patterns of infection in patients maintained on long-term peritoneal dialysis therapy with multiple episodes of peritonitis.

The causes of peritonitis in patients with end-stage renal disease maintained on long-term peritoneal dialysis (PD) are unclear. One possible explanation for peritonitis, particularly in patients with multiple episodes of infection, is the release of planktonic bacteria from biofilm on the walls of catheters. Bacteria form biofilm on the walls of catheters within 48 hours of their placement. If this explanation were correct, one would expect there to be reappearance of organisms causing infection in patients with multiple episodes of peritonitis. The charts of all patients starting long-term PD at New Haven CAPD from January 1, 1990, through July 31, 2000, were reviewed. Patients were included in the study if they had experienced more than one episode of culture-positive peritonitis and complete data were available concerning cultured organisms and antibiotic sensitivity patterns. Episodes of infection, organisms, and sensitivities and catheter changes were reviewed. Of 630 patients, 198 were identified as meeting these criteria. There were 114 men; 104 patients were white. Of 198 patients, 157 (80%) had at least one repeat infection with the same organism. In 124 (79%) patients, more than 50% of the peritonitis episodes were caused by the same organism. Of 90 patients who had more than four episodes of infection in their history, 59 (65%) had at least half or more of their episodes caused by the same organism. Sequential analyses for independence revealed that for Staphylococcus epidermidis and for Staphylococcus aureus, there was a significantly increased likelihood for these organisms to follow themselves as causative organisms of peritonitis. When the data were analyzed using the Spearman correlation test, the results indicated that the likelihood of repeat infections occurring was significantly greater than by chance alone. Of 67 patients with catheter changes and subsequent peritonitis, only 10 (15%) developed repeat infections with the same organism after the catheter change. Eight of these were due to yeast. These data support the hypothesis that bacterial biofilm on the walls of peritoneal catheters may be associated with peritonitis in patients maintained on long-term PD and may contribute to at least some of these episodes of infection.

Adult↗
PubMed2002

Comparison of quality-of-life assessment in Russia and the United States in chronic peritoneal dialysis patients.

Numerous reports of quality-of-life data in chronic peritoneal dialysis (CPD) patients in the United States and Western Europe use the short form questionnaire (SF-36). Few centers in Europe have reported data examining the incidence of depression in CPD patients. Depression has been shown to correlate with morbidity and mortality in dialysis patients. A high incidence of clinical depression is seen in end-stage renal disease patients in the United States. We thought it could be important to compare depression measurements between the United States and European countries. Quality-of-life data of the peritoneal dialysis patients from the New Haven continuous ambulatory peritoneal dialysis (CAPD) unit and from the New Technology Center at Hospital #31 in St. Petersburg were compared. The Beck Depression Inventory (BDI) and the SF-36, which includes the mental component score (MCS) and the physical component score (PCS), were administered to the patients. The study participants included 147 Russian and 96 U.S. patients. The BDI, PCS, and MCS scores were similar in both groups. The BDI scores in the Russian patients indicated that a high incidence of clinical depression likely exists in that patient population. The utility of the BDI in assessing quality-of-life issues in Europe and Russia requires further evaluation.

Activities of Daily Living↗
PubMed2002

Racial differences and peritonitis in an urban peritoneal dialysis center.

Racial differences have been reported among various groups with end-stage renal disease maintained on dialysis. In particular, patient survival on dialysis has been reported to be better in African-American patients than in Caucasian patients. Peritonitis rates and dropout from chronic peritoneal dialysis (CPD) have been reported to be higher in African-American patients. We decided to review our experience with peritonitis rates in African-American and Caucasian patients. From 1994 to 2000, 403 patients were maintained on CPD in the New Haven continuous ambulatory peritoneal dialysis (CAPD) unit. Peritonitis rates were 1 episode in 14 patient-months in Caucasian patients and 1 episode in 13.6 patient-months in African-American patients. Mean ages at the start of dialysis were 52.4 +/- 16.2 years in the Caucasian patients and 62.6 +/- 14.9 years in the African-American patients. African-American patients were older. African-American and Caucasian patients had similar peritonitis rates. Time of first episode of peritonitis was not different in the two groups.

Adult↗
PubMedDate not supplied

APD in the elderly.

Few elderly patients with end-stage renal disease (ESRD) are treated with peritoneal dialysis (PD). Among dialysis patients >or=65 years of age reported by the U.S. Renal Data System (USRDS), the percentage treated with chronic peritoneal dialysis (CPD) is lower than in any other age group. To evaluate the effectiveness of automated peritoneal dialysis (APD) in the elderly, we compared several outcome measures in cohorts of different ages maintained on APD. The outcome measures we examined included mortality and technique failure rates, peritonitis rates, outcomes of peritonitis, and quality of life measures. We found that while patients >or=65 years of age have a higher mortality rate than younger patients, technique failure rates, overall peritonitis rates, and most quality of life measures are not different than for younger patients. However, patients >or=65 years of age have higher gram-negative peritonitis rates and lower scores on the physical component score of the SF-36 than younger patients. The present study suggests that APD is a reasonable treatment modality for elderly patients with ESRD and that elderly patients with progressive renal failure should be considered as candidates for APD.

Aged↗
PubMedDate not supplied

Chronic peritoneal dialysis patients diagnosed with clinical depression: results of pharmacologic therapy.

Depression has been documented as the most frequently encountered psychological problem in end-stage renal disease (ESRD) patients and has been correlated with both mortality and morbidity in these patients. Previous work by our group has shown that clinical depression is treatable with psychotropic medications in these patients, but that only a limited number of ESRD patients with depression will successfully complete a course of pharmacologic therapy. From July 1997 to October 2002, all chronic peritoneal dialysis (PD) patients in our facility were encouraged to be screened for depression utilizing the self-administered Beck Depression Inventory (BDI) questionnaire. Based on previous work, a score > or =11 on this questionnaire was used to indicate a possible diagnosis of clinical depression; patients with BDI scores > or =11 were encouraged to complete a more formal evaluation for the presence of clinical depression. A total of 320 BDI questionnaires were completed during the study period: 134 patients. (42%) scored > or =11 on the BDI, 69 of the 134 patients (51%) with BDI scores > or =11 agreed to further evaluation. Sixty of these 69 patients (87%) were diagnosed with clinical depression based on scores > or =18 on the Hamilton Depression Scale and standard Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria. Forty-four patients with clinical depression agreed to pharmacologic treatment. However, only 23 of the 44 patients (52%) successfully completed a 12-week course of drug therapy. Two unit social work reviewers systematically reviewed the records of these 21 patients who did not complete therapy and assessed the reasons for their inability to complete treatment. Reasons identified included eight patients who experienced acute medical problems, three who were active substance abusers, and two who reported medication side effects. The remaining eight patients who did not complete the 12 weeks of therapy were examined by applying the axis 1 and axis 2 DSM-IV criteria. Axis 1 is used to diagnose clinical disorders and axis 2 is used to diagnose personality disorders. While all these patients met the DSM-IV axis 1 criteria for clinical depression, eight of these patients met axis 2 criteria for personality disorders; five patients had borderline personality disorders, one had a narcissistic personality disorder, one had a factitious disorder, and one had features of avoidant personality disorder. While some chronic PD patients can be successfully treated for clinical depression with psychotropic medication prescribed by the dialysis medical team, not all patients will agree to be evaluated for clinical depression and accept pharmacologic treatment. Others cannot or will not complete treatment when additional psychiatric disorders exist. These patients may require additional intervention when diagnosed with clinical depression and a personality disorder. Further trials are warranted.

Antidepressive Agents↗
PubMedDate not supplied

Continuous peritoneal dialysis-associated peritonitis: a review and current concepts.

The percentage of end-stage renal disease (ESRD) patients in the United States maintained on continuous peritoneal dialysis (CPD) therapy is decreasing. Complications from CPD therapy, including peritonitis, may be the reason for the decline. Improvements in CPD technology and a better understanding of the risk factors that predispose patients to the development of peritonitis have been responsible for a decline in the rate of peritonitis. Yet peritonitis remains a significant cause of patient morbidity and mortality and the overall outcome of peritonitis is not acceptable. Factors that have limited our ability to lessen the impact of peritonitis include a lack of data on dosing antibiotics in patients on continuous cycling peritoneal dialysis (CCPD) therapy, a lack of knowledge concerning the biology of bacterial biofilm, and the development of resistance to the current prophylactic antibiotic protocols. Further studies are needed concerning the optimal management of the peritoneal catheter and whether it is feasible to resume CPD therapy after catheter removal.

Anti-Bacterial Agents↗
PubMedDate not supplied

The identification and treatment of depression in patients maintained on dialysis.

The high incidence of depression in end-stage renal disease (ESRD) patients is well documented. Our group and others have estimated that 20-30% of ESRD patients experience major depression. Several recent studies have emphasized the relationship between depressive symptoms and mortality and morbidity in both hemodialysis (HD) and peritoneal dialysis (PD) patients. We screened 380 PD patients for depression using the Beck Depression Inventory (BDI). The mean patient age was 59.9 +/- 14.1 (SD) years, 55% were Caucasian, 51% were male, and 39% had diabetes. The mean BDI score was 12.1 +/- 7.7; 49% had a score of 11 or greater. Fifty-five percent refused further assessment to confirm the diagnosis of major depression, while 45% of patients eligible for treatment agreed to further assessment. Their mean BDI was 18.8 +/- 6.2. Eighty-four percent were diagnosed with major depression on direct interviews and offered pharmacologic treatment, 16% did not meet the criteria for a diagnosis of depression, and 50% successfully completed 12 weeks of pharmacologic treatment. The BDI score of these patients at the start of treatment was 17.4 +/- 6.6, and at completion of treatment it was 8.4 +/- 3.0. Thirty-eight percent of treatment failures were in those who were also diagnosed with a DSM-IV personality disorder. Major depression is common in PD patients, and is potentially treatable with pharmacologic therapy. However, there are major problems providing a depression assessment and treatment program to such patients. Problems include refusal to complete depression assessment and patients with axis 2 personality disorders who have difficulty complying with treatment. Although depression treatment can improve depressive symptoms, it is unclear whether such therapy will improve medical outcomes.

Antidepressive Agents↗
PubMedDate not supplied

Patients' descriptions of specific factors leading to modality selection of chronic peritoneal dialysis or hemodialysis.

OBJECTIVES: There has been increasing interest in understanding how patients with chronic renal failure choose between chronic peritoneal dialysis (CPD) and hemodialysis (HD) for renal replacement therapy. The purpose of the present study was to examine the influences and specific factors that patients identify as significant in choosing a specific dialysis modality for treatment of their end-stage renal disease (ESRD). PATIENTS AND DESIGN: 40 patients (20 CPD, 20 HD) who had started dialysis within the preceding 6 months were randomly selected to participate in the study. A structured interview was conducted with the patients, discussing and exploring what factors patients thought were important in helping them decide their treatment modality. The format of the interview was open-ended. Based on patients' comments, a taxonomy of the specific factors that influenced the patients' decisions was developed. SETTING: The study was conducted in a freestanding CPD unit and two freestanding HD units. RESULTS: All 20 CPD patients reported choosing their treatment modality; only 8 of the 20 HD patients reported having a choice of treatment modality. 18 of the 22 patients who participated in predialysis educational programs opted for CPD. 83% of the patients reported that their physician was important in influencing their treatment choice; however, the CPD patients relied more on written material and the opinions of their spouse/significant other or other family members in making their decisions. Issues of autonomy and control were important for 95% of patients choosing CPD. Both CPD and HD patients cited a variety of treatment-specific factors. The three most frequently cited reasons for choosing CPD were (1) flexibility of schedule (19 patients), (2) convenience of performing CPD in their own home (19 patients), and (3) the option of doing dialysis at night while sleeping (8 patients). The 8 HD patients who selected their treatment modality cited the desirability of having a planned schedule (7 patients) and letting nurses or other take care of them (5 patients). CONCLUSIONS: The present study explored factors perceived by patients as being important in determining their choice of renal replacement therapy. A taxonomy of patient influences and concerns has been developed to provide caregivers with a framework to structure their educational strategies and assist patients with progressive renal failure in making an informed choice of therapeutic modality for their ESRD treatment.

Decision Making↗
PubMedDate not supplied

Increasing the dialysis volume and frequency in a fixed period of time in CPD patients: the effect on Kpt/V and creatinine clearance.

BACKGROUND: The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) has evidence- and opinion-based recommendations for weekly Kt/V(urea) and weekly total creatinine clearance (CC) in chronic peritoneal dialysis (CPD) patients. Using standard continuous ambulatory peritoneal dialysis technique, it is often difficult to achieve the suggested targets in anuric patients with large body mass. Thus, the use of automated peritoneal dialysis (APD) has been increasingly utilized to achieve adequate clearances. Automated dialysis is usually performed at night over an 8- to 10-hour period. The role of increases in dialysate volume and frequency of exchanges during this time period to achieve these target K/DOQI recommendations remains uncertain. We decided to study the effects of increasing the volume and number of exchanges in a fixed period of time in CPD patients. METHODS: In the New Haven CAPD unit, 29 patients maintained on APD were considered eligible for the study and 11 agreed to participate. The patients were characterized according to standard peritoneal equilibration test criteria. The patients were placed into two groups: group 1 included high (H) and high-average (HA), and group 2 low-average (LA) transporters. The patients were dialyzed at night for 9 hours with standard cycling technique, using 2.5% Dianeal (Baxter Healthcare, Deerfield, Illinois, USA) solution, with a cycle volume of 2,500 mL, and a 2,000-mL daytime dwell. Three studies were done on each patient using a total dialysis volume of 9.5 L (3 cycles), 14.5 L (5 cycles), and 19.5 L (7 cycles). Daily Kpt/V(urea) and daily CCp (peritoneal) (L/day/1.73 m2) were obtained. RESULTS: Six patients were H or HA (group 1) and 5 were LA transporters (group 2). For the group 1 patients, mean weight was 86.6 +/- 13.5 kg; Kpt/V(urea) was 1.68 +/- 0.21 using 9.5 L, 2.03 +/- 0.28 for 14.5 L (p < 0.05 compared to 10 L), and 2.28 +/- 0.28 with 19.5 L (p < 0.05 compared to 10 L and 15 L); mean weekly CCp was 45.43 +/- 7.63 L/1.73 m2 for 9.5 L (p < 0.05 compared to 14.5 L and 19.5 L), 51.17 +/- 7.07 with 14.5 L, and 54.67 +/- 10.08 for 19.5 L; ultrafiltration rates were not different in the three studies. For the group 2 patients, mean weight was 74.3 +/- 17.7 kg; mean weekly Kpt/V(urea) was 1.68 +/- 0.35 using 9.5 L, 2.10 +/- 0.42 for 14.5 L (p < 0.05 compared to 9.5 L), and 2.31 +/- 0.56 for 19.5 L (p < 0.05 compared to 9.5 L and 14.5 L); mean weekly CCp was 42.56 +/- 10.64 L/1.73 m2 for 9.5 L (p < 0.05 compared to 14.5 L and 19.5 L), 50.89 +/- 12.66 for 14.5 L, and 51.94 +/- 11.20 for 19.5 L; ultrafiltration was lower in the 9.5-L study than in the 14.5-L and 19.5-L studies, but was not different in the 14.5-L and 19.5-L studies. CONCLUSIONS: In both H/HA and LA transporters, Kpt/V(urea) and CCp rise significantly when the frequency of exchanges and total volume of dialysate are increased. Thus, the use of larger volumes of dialysate with cycling peritoneal dialysis may result in increased clearances of urea and creatinine.

Adolescent↗