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Longitudinal influence of age, menopause, hormone replacement therapy, and other medications on parotid flow rates in healthy women.

BACKGROUND: Recent investigations have demonstrated that parotid salivary dysfunction is not a normal process of aging, but may be the consequence of systemic conditions and their treatment, including medications and menopause. The purpose of this study was to assess longitudinally the influence of age, menopausal status, hormone replacement therapy, and other medications on stimulated parotid flow rates (SPFRs) in healthy women. METHODS: Medical diagnoses, menopausal status, medication utilization, and 2% citric acid stimulated parotid salivas were collected from 396 women, aged 21 to 96 years, from the Baltimore Longitudinal Study of Aging (National Institute on Aging, National Institutes of Health) over a 17-year span by three investigators. RESULTS: There was no overall longitudinal effect of time on SPFR. Age at first visit was a significant predictor of a decrease in SPFR when adjusted for time and xerostomic medications. However, the deleterious effect of taking one xerostomic medication was equivalent to approximately 14 years of aging. Menopausal status and hormone replacement therapy were not consistently associated with diminished SPFR. CONCLUSIONS: These results suggest that menopause and hormone replacement therapy are not associated with parotid salivary dysfunction. Aging may have a statistically significant yet small deleterious influence on SPFR; however, the adverse influence of xerostomic medications is much larger.

Adult↗

Cross-sectional and longitudinal association between antihypertensive medications and cognitive impairment in an elderly population.

BACKGROUND: The effect of antihypertensive medications on cognitive function has not been well studied. The authors' objectives were to investigate the cross-sectional and longitudinal association between the use of antihypertensive medications and cognitive function and to compare different antihypertensive medication classes with regard to this association in an elderly population. METHODS: The medical records of a convenience sample of patients (n = 993 cross-sectional and 350 longitudinal; mean age, 76.8 +/- 0.3 years; 74% women; 87% White) followed at a geriatric practice were reviewed. Data abstracted included demographics, medical history (Alzheimer's disease [AD] or vascular dementia [VaD]), use of antihypertensive medications, and results of cognitive assessments (the Mini-Mental Status Examination [MMSE] and the Clock Draw Test [CDT]). RESULTS: In the cross-sectional analysis, antihypertensive use was not associated with MMSE (p >.05), CDT (p >.05), or dementia diagnosis (odds ratio for AD, 0.8; 95% confidence interval [CI], 0.6 to 1.2; odds ratio for VaD, 1.6; 95% CI, 0.6 to 4.0). In the longitudinal analysis, antihypertensive use was associated with a lower rate of cognitive decline on the MMSE (-0.8 +/- 2 points in users vs -5.8 +/- 2.5 points in nonusers; p =.007) and on the CDT (-0.3 +/- 0.8 points in users vs -2.2 +/- 0.8 points in nonusers; p =.002), and with a lower risk for the development of cognitive impairment (odds ratio, 0.56; 95% CI, 0.38 to 0.83; p =.004). The trend was similar in patients with baseline AD (p =.02). Patients taking diuretics (p =.007), angiotensin-converting enzyme inhibitors (p =.016), and beta-blockers (p =.014) had a lower rate of cognitive decline, and patients taking angiotensin receptor blockers (p =.016) had improved cognitive scores. CONCLUSIONS: Antihypertensive use, particularly diuretics, angiotensin-converting enzymes inhibitors, beta-blockers, and angiotensin receptor blockers, may be associated with a lower rate of cognitive decline in older adults, including those with AD. Until a randomized clinical trial confirms our results, findings of this observational study should be interpreted with caution.

Adult↗

Longitudinal changes in aerobic capacity: implications for concepts of aging.

BACKGROUND: Whereas aerobic capacity declines with age, major factors responsible for such decline have been poorly defined by past studies. METHODS: Participants were relatively healthy older individuals (339 women, 253 men) in whom demographic information and cardiopulmonary physiological measurements were obtained at baseline and biannually for three additional measurements. RESULTS: The study identified progressive declines in both forced expiratory volume in 1 second (FEV(1)) and in maximal exercise heart rate as two variables that accounted primarily for the longitudinal decline of aerobic performance in this cohort of relatively fit older persons who achieved high respiratory exchange ratios (RER; mean = 1.08 for women, 1.12 for men). Whereas women achieved a peak oxygen consumption (VO(2peak)) only 77% that of men, oxygen uptake became similar to men (to 95%) when measured per kilogram of lean body mass rather than per kilogram of total body mass. During the 6 years of the study (four time points) aerobic capacity declined in both sexes, however, less steeply for women than for men (18% vs 24% per decade, respectively). The rate of decline was independent of baseline variables such as body composition (e.g., lean body mass, lean/fat ratio), smoking status, medications, or concomitant health conditions, even though these variables strongly influenced baseline aerobic performance. Inclusion of FEV(1) and maximal exercise heart rate into the statistical models, however, accounted for most of the longitudinal decline of aerobic performance. When adjusted for these two variables, aerobic capacity declined 9.7% and 10.4% per decade in women and men, respectively. CONCLUSIONS: Our findings emphasize the primary importance of declining FEV(1) and declining maximal exercise heart rate in accounting for the "aging effect" on aerobic capacity. Thus, when comparing longitudinal studies, all estimates of aerobic decline should be interpreted with respect to the specific variables included in the models, which also need to include FEV(1) and maximal exercise heart rate.

Aged↗

Age differences and age changes in activities: Baltimore Longitudinal Study of Aging.

This study examines cross-sectional age differences, longitudinal age changes, and secular changes in obligatory, committed, and discretionary activities, using activity questionnaire completed by men and women participants in the Baltimore Longitudinal Study of Aging between 1958 and 1992. (1) Time spent, on obligatory activities and passive leisure is greatest, and on committed activities and active leisure least, for older adults. (2) Longitudinal patterns usually mirror cross-sectional ones. There are pronounced exceptions for women whose paid work time has been increasing and housework decreasing, while cross-sectional patterns show the reverse. (3) Over recent decades, time in committed activities shifted in opposite ways for men and women. Men decreased paid work and increased housework, repairs and yardwork, shopping, and child-care, while women increased paid work and decreased housework. In sum, the age structure of activities has persisted in the midst of new social opportunities; gender roles have proven more malleable than age roles.

Activities of Daily Living↗

Longitudinal changes in quantitative and qualitative indicators of word and story recall in young-old and old-old adults.

The present study examined longitudinal changes in quantitative and qualitative measures of episodic memory. The sample, taken from the Victoria Longitudinal Study, consisted of 158 young-old adults (initially 55 to 70 years old) and 84 old-old adults (initially 71 to 86 years old) who were tested three times over six years. Average word and text recall, as well as five indicators of qualitative aspects of word recall (e.g., number of categories recalled) and one indicator of structure of text recall (i.e., levels of information) were used. For word recall, although both age groups exhibited negative longitudinal changes in quantitative performance, overall qualitative performance was generally stable. Two qualitative indicators (number of categories and intrusions) showed modest decline and one (organization at recall) showed improvement. Results for overall text recall showed significant performance increments for the young-old group, whereas the old-old group exhibited slight declines in overall performance. Analyses of qualitative measures showed stable structure of hierarchical recall, with the old-old being impaired at all levels of detail in the stories. Overall results suggest that some underlying structural characteristics of word and text recall may be maintained into late life even when significant overall decline is observed.

Age Factors↗

How older people in the United States and Germany fared in the growth years of the 1980s: a cross-sectional versus a longitudinal view.

OBJECTIVES: The goal of the study was to show that cross-sectional and longitudinal data yield dramatically different answers to a basic question: "How did older persons fare in the recovery years of the 1980s?" METHODS: The United States Panel Study of Income Dynamics and the German Socio-Economic Panel are used cross-sectionally to capture changes in the economic well-being of older persons in the trough and peak years of the 1980s business cycle, and longitudinally to trace how the economic well-being of a given cohort of older persons changed over those years. Kernel density estimation is then used to show how the distribution of economic well-being of these populations changed over these years. RESULTS: Cross-sectional comparisons confirm that persons aged 65 and over in the peak year were better off than persons aged 65 and over in the trough year in both countries. Longitudinal comparisons, however, show that persons aged 65 and over in the trough year who survived to the peak year received a substantially smaller share of the rewards of economic recovery than cross-sectional comparisons imply. Moreover, the entire income distribution of older persons in the United States shifted downwards. DISCUSSION: Compositional changes in the cross-sectional data, caused by the entry of high-income persons who are young in the peak year but old in the trough year, obscure the decline in the economic well-being of the cohort of older persons who survived the trough year, in cross-sectional comparisons of older populations in the United States in the 1980s.

Age Factors↗

A half century of longitudinal methods in social gerontology: evidence of change in the journal.

OBJECTIVES: With a focus on the use of longitudinal data, this study reviews trends in the quantitative analysis of social science data on aging during the past half century. METHODS: A content analysis was performed on 227 articles from 12 volumes that were systematically sampled from the Journal of Gerontology: Social Sciences to examine change in the type of data and quantitative methods used (1946-2000). RESULTS: Cross-sectional analysis remains the single most frequent type of study, but the publication of analyses based on longitudinal panel data increased appreciably over the five decades studied. There was little increase in the use of repeated cross-sectional analysis. DISCUSSION: Despite the widespread use of cross-sectional analysis, interest in data with more than one occasion of measurement has grown among social scientists who are reviewing for and publishing in the JOURNAL. Given the longitudinal data now available, social science research on aging should give more explicit attention to three issues: attrition, change in repeated measures of independent variables, and models to account for many waves of data.

Bibliometrics↗

Continuity and change in the social stratification of aging and health over the life course: evidence from a nationally representative longitudinal study from 1986 to 2001/2002 (Americans' Changing Lives Study).

OBJECTIVES: This article overviews previously published and ongoing research from the Americans' Changing Lives (ACL) Study, a longitudinal study of a nationally representative sample of 3,617 adults aged 25 years and older when first interviewed in 1986, focusing on socioeconomic disparities in the way health changes with age during middle and later life, especially in terms of compression of morbidity/functional limitations. METHODS: A variety of descriptive and multivariate regression and growth curve analyses are done on the ACL sample, now surveyed over four waves spanning 15.5 years between 1986 and 2001/2002 with continuing mortality ascertainment via the National Death Index, death certificate searches, and informant reports. RESULTS: Both cross-sectional and longitudinal analyses indicate that socioeconomic disparities in health are small in early adulthood, increase through middle and early old age, and then lessen again in later old age. In other terms, compression of morbidity/functional limitations into the later stages of the life course is realized to a much greater degree among the better educated compared with the less educated. Cross-sectional evidence suggests that this reflects differential exposure to or experience of a wide range of psychosocial, environmental, and biomedical risk factors for health (and perhaps their differential impact at different ages and life stages), as well as variations in biological robustness and frailty and also perhaps in the strength of social welfare supports for health at different life stages. Longitudinal analyses reveal several new insights: (a) The flow of causality is much greater from socioeconomic position to health than vice versa; (b) education plays a greater role relative to income in the onset of functional limitations, whereas income has much stronger effects on their progression or course; and (c) educational disparities in the onset and hence of compression of functional limitations over the life course have increased strikingly in later middle and early old age (ages 55-84 years) since 1986. DISCUSSION: The results indicate that understanding and alleviating social disparities in health are both theoretically and methodologically quintessential problems of life course analysis and research.

Adult↗

Constancy of adult personality structure in males: longitudinal, cross-sectional and times-of-measurement analyses.

Constancy or change in adult personality organization can be assessed by comparing the factor structure of personality instruments at different ages, and some studies have reported cross-sectional differences in structure. The present study compares the factor structure of the Guilford-Zimmerman Temperament Survey scales longitudinally in three administrations 6 years apart and cross-sectionally in three age cohorts. Additional analyses compare first administration data collected in two successive decades to test for variation in structure resulting from cultural change over that period. Subjects were 769 male volunteers in the Baltimore Longitudinal Study of Aging, aged 17 to 97 at the time of the first administration. Three varimax-rotated principal components were extracted in each of eight analyses. Results show no systematic evidence of variation in structure in any of these groups, with coefficients of factor congruence ranging from .83 to .99. This longitudinally demonstrated invariance of personality structure is discussed in terms of the implications for the stability of personality organization throughout the adult years and for the use of personality tests in elderly groups.

Adolescent↗

Next steps in describing aging and disease in longitudinal studies.

Longitudinal studies have contributed much to the understanding of aging. Traditionally, age-specific changes in physiological functioning are inferred from studies in which persons with disease processes believed to be relevant to the function in question are excluded from the results. The main theme of this review is that, in the future, studies of aging must better attempt to capture the interplay between disease and aging processes. A variety of research results, mostly from the Baltimore Longitudinal Study of Aging, are used to support this argument. Topics covered include: the role of longitudinal studies in aging research; the complexity of the aging process; the significance of cohort and secular changes for understanding both aging and disease processes; age changes over the adult life span in the significance of risk factors for disease; and age-related increases in morbidity in a longevous group of men.

Aging↗

Continuing diet trends in men: the Baltimore Longitudinal Study of Aging (1961-1987).

Due to increasing evidence for the role of nutrition as a cause of illness and of the efforts of health agencies to induce Americans to change their diets, it is important to monitor populations for changes in their nutrient intakes. Seven-day diet records were collected from 105 free-living men in the 1960s, 1970s, and 1980s. Age range was initially 27 to 65 and finally 50 to 88 years. The men were divided into age groups so that longitudinal, time series, and cross-sectional analyses could distinguish among differences due to aging, cohort, and secular change. Longitudinal decreases over three decades of time include height, intakes of kcal/day, kcal/kg, kcal from fat, and cholesterol (all p less than .0001). Longitudinal increases over time include body weight, intakes of kcal from alcohol (p = .002), kcal from carbohydrate, and polyunsaturated to saturated fatty acid ratio (P/S) (all p less than .0001). Values that correlated cross-sectionally with age in the 1960s were height, kcal/day, kcal/kg, kcal from protein, and P/S ratio; height, intakes of kcal from protein, and fiber in the 1970s; and body weight, height, intakes of kcal from carbohydrate and fiber in the 1980s (all p less than .05). Protein consumption remained constant while carbohydrate increased as time passed. The more striking secular changes were in type and amount of fat consumed (42% to 34% of kcal, a 37% decline in cholesterol and a 72% increase in P/S ratio). Voluntary changes in the diets of these community-dwelling men indicate that, at any age, men can make beneficial changes in intake of nutrients that affect health.

Adult↗

Cross-sectional age differences and longitudinal change on the Bradburn Affect Balance Scale.

Cross-sectional age differences and longitudinal change were examined on psychological well-being, positive affect, and negative affect, as measured by the Bradburn Affect Balance Scale. Data were collected from 1,159 participants in 1971 and 1985. Cross-sectional analyses showed age differences: older cohorts reported greater overall well-being but lower levels of both positive and negative affect when compared to younger respondents. Longitudinal analyses indicated small but significant changes toward decreased positive and negative affect but increased overall well-being. Negative affect had the strongest effect size. Positive and negative affect showed different patterns of change for different age groups. Taken together, cross-sectional and longitudinal findings suggest that change in affect variables is age-related, although these changes are relatively small. More evident was a pattern of correlational stability with age. Finally, the pattern of the results supports a two-factor theory of psychological well-being.

Adolescent↗

Neuroticism and longitudinal change in caregiver depression: impact of a spouse-caregiver intervention program.

PURPOSE: We examined the impact of caregiver neuroticism on longitudinal change in depression among spouse-caregivers of individuals with Alzheimer's disease receiving either enhanced psychosocial treatment or usual care. We were interested in whether high levels of caregiver neuroticism would lead to a diminished response to the enhanced treatment and whether neuroticism affected the longitudinal course of caregiver depression regardless of intervention. DESIGN AND METHODS: We analyzed data from the NYU Spouse-Caregiver Intervention Study, which randomly assigned caregivers either to an enhanced treatment group that received a comprehensive intervention with counseling, support, and consultation, or to a usual-care control group. The present study analyzed data from 320 caregivers, 160 in each group, who completed the NEO questionnaire. We used random-effects growth curve modeling to examine changes in depression in the first year after intake, examining possible effects of neuroticism on the course of caregiver depression and on response to intervention. RESULTS: Caregivers high in neuroticism showed a worse longitudinal course of depression compared with those low in neuroticism in both the enhanced treatment and usual-care groups after we adjusted for baseline depression as a covariate. Caregivers showed benefits from the enhanced treatment compared with usual care, regardless of neuroticism score. However, caregivers low in neuroticism responded to treatment with declining levels of depression, whereas caregivers high in neuroticism maintained their baseline level of depression. IMPLICATIONS: Caregiver neuroticism is a risk factor for increased caregiver depression over time. High neuroticism does not preclude successful caregiver intervention with a highly individualized intervention like ours, but expectations of outcome should be different than for caregivers low in neuroticism. Future studies should investigate the relationship between neuroticism and response to less individualized interventions and the impact of other personality characteristics on response to treatment.

Aged↗

The longitudinal relationship between the use of long-term care and depressive symptoms in older adults.

PURPOSE: The aim of this study was to estimate the longitudinal relationship between transitions in the use of long-term care and older adults' depressive symptoms and to investigate whether this relationship could be explained by markers of older adults' underlying health, or other variables including demographics, personality, and partner status. DESIGN AND METHODS: Data were from the Longitudinal Aging Study Amsterdam, which consists of a random, community-based sample of 3,107 older Dutch people (55-85 years of age) stratified by age and gender. The use of informal care, professional home care, and institutional care was recorded, and respondents were screened on depressive symptoms. Follow-up measurements took place at 3 and 6 years. RESULTS: Longitudinal analyses showed significant associations between the enduring use of professional long-term care and an increase in depressive symptoms. Transitions to professional home care or institutional care were also associated with considerably more depressive symptoms after 3 years, whereas transitions from professional home care or institutional care to no care or informal care only were not associated with a change in depressive symptoms. Most of the associations remained significant after indicators of underlying health and other covariates were adjusted for, and also after the data were reanalyzed for respondents with and without functional limitations. IMPLICATIONS: This study does not involve a controlled experiment of professional long-term care among older adults. However, the findings suggest the possibility that receiving professional long-term care could introduce new stressors and increase the risk of depressive symptoms. Our analyses illuminate the concerns of elders regarding their use of professional long-term care and may help in planning for more effective delivery of this type of care.

Aged↗

A longitudinal study of maternal serum vascular endothelial growth factor in early pregnancy.

Using a competitive radioimmunoassay to measure total immunoreactive vascular endothelial growth factor (VEGF), we describe for the first time longitudinal changes in serum VEGF in early pregnancy. The measurements were obtained from 26 women following the transfer of cryopreserved embryos; 18 singleton and eight twin pregnancies were identified by ultrasound at 6 weeks gestation and subsequently delivered as live births. Subjects did not have corpora lutea and exogenous hormone support was provided for the first 70 days of pregnancy. Serum VEGF increased approximately 30 days after embryo transfer and thereafter continued to rise in both singleton and twin pregnancies over a period of 20-40 days after which concentrations remained elevated. The longitudinal profile of serum VEGF concentrations was characterized by a logistic curve for singleton and twin pregnancies; the profile of VEGF concentrations in the twin pregnancies was significantly higher than in the singleton pregnancies (P < 0.0001). Profiles of the longitudinal concentrations of serum human chorionic gonadotrophin (HCG), oestradiol and progesterone were created by polynomial regression for singleton and twin pregnancies. The VEGF profiles were positively correlated with the profiles of HCG (r = 0.44, P = 0.02) and oestradiol (r = 0.36, P = 0.07) but not progesterone (r = 0.16, P = 0.42). Serum VEGF concentrations in the singleton thawed embryo pregnancies were compared with gestation-matched normal singleton pregnancies with corpora lutea. Concentrations of VEGF were significantly (P = 0.004) greater in the pregnancies with corpora lutea although this difference became less marked with advancing gestation. In addition to its important role in angiogenesis, we speculate that VEGF is involved in mechanisms which control the maternal cardiovascular adaptation to pregnancy.

Chorionic Gonadotropin↗

A longitudinal comparison of body composition by total body water and bioelectrical impedance in adolescent girls.

Previous studies have assessed the ability of bioelectrical impedance analysis (BIA) to estimate body composition cross-sectionally, but less is known about the ability of BIA to detect changes in body composition longitudinally over the adolescent growth period. Body composition was assessed by isotopic dilution of H(2)(18)O and BIA in 196 initially nonobese girls enrolled in a longitudinal study. Two prediction equations for use in our population of girls were developed, one for use premenarcheally and one for use postmenarcheally. We compared estimates from our equation with those derived from several published equations. Using longitudinal data analysis techniques, we estimated changes in fat-free mass (FFM) and percentage body fat (%BF) over time from BIA, compared with changes in FFM and % BF estimated by H(2)(18)O. A total of 422 measurements from 196 girls were available for analysis. Of the participants, 26% had one measurement of body composition, 43% had two measurements of body composition and 31% had three or more measurements of body composition. By either H(2)(18)O or BIA, the mean %BF at study entry was 23% (n = 196) and the mean %BF at 4 y postmenarche was 27% (n = 133). In our cohort, the best predictive equations to estimate FFM by BIA were: PREMENARCHE: FFM = -5.508 + (0.420 x height(2)/resistance) + (0.209 x weight) + (0.08593 x height) + (0.515 x black race) - (0.02273 x other race). POSTMENARCHE: FFM = -11.937 + (0.389 x height(2)/resistance) + (0.285 x weight) + (0.124 x height) + (0.543 x black race) + (0.393 x other race). Overall, we found that BIA provided accurate estimates of the change in both FFM and %BF over time.

Adolescent↗

Longitudinal relationships of depressive symptoms to pain intensity and functional disability among children with disease-related pain.

OBJECTIVE: To examine the longitudinal relationship between depressive symptoms at study entry (T1) on pain intensity (PI) and functional disability over a 1-year period among children with either sickle cell disease (SCD) or juvenile idiopathic arthritis (JIA). METHODS: 119 children, ages 8-17 years, completed measures of depression at T1 as well as pain and functional disability at T1, 6-month (T2), and 12-month (T3) follow-ups. Caregivers also rated their child's pain and disability at each time point. General linear mixed modeling was employed to examine longitudinal relationships between study variables. RESULTS: For children with JIA, T1 pain significantly moderated the effects of T1-depressive symptoms on T2 and T3 pain where T1-depressive symptoms predicted future child-reported pain only when T1 pain was relatively mild. Similarly, T1-depressive symptoms predicted future child-reported disability only when initial reports of disability were relatively low. Only family income significantly predicted T2 and T3 pain in children with SCD. CONCLUSIONS: Study findings suggest that T1-depressive symptoms play a role in the longitudinal course of pain symptoms in children with JIA but not in children with SCD.

Activities of Daily Living↗

Evaluation of peritoneal transport properties at onset of peritoneal dialysis and longitudinal follow-up.

BACKGROUND: The clinical determinants of baseline peritoneal membrane (PM) transport characteristics, as evaluated by a hypertonic peritoneal equilibration test (PET), remain ill-defined. Likewise, the longitudinal evolution of PM transport properties in peritoneal dialysis (PD) patients given automated PD (APD) and icodextrin still needs to be determined precisely. The aims of the present study were (1) to determine the clinical and biological factors affecting PM transport characteristics at PD onset and (2) to assess the longitudinal evolution of these markers. METHODS: Seventy-two consecutive patients performed a baseline 3.86% glucose dialysate PET and were enrolled. Subgroups of 35 and 18 patients underwent another PET 1 and 2 year(s) later, respectively, and were included in the longitudinal part. For each patient, clinical and biological data were reviewed and PM transport markers calculated. RESULTS: At onset of PD, angiotensin-converting enzyme (ACE) inhibitor intake (r = 0.31, P = 0.01), presence of a diabetes (r = 0.26, P = 0.03) and body surface area (BSA) (r = 0.26, P = 0.03) independently affected the mass transfer area coefficient (MTAC) of creatinine. Serum albumin (r = -0.46, P<0.001) and net ultrafiltration (r = -0.33, P = 0.009) inversely correlated with MTAC creatinine. Sodium sieving was inversely correlated with BSA (r = -0.33, P = 0.01). Serum albumin also inversely correlated with albumin clearance (r = -0.39, P = 0.02). Finally, the independent covariates that affected alpha2-macroglobulin clearance were age (P = 0.03), diabetes (P = 0.01) and the level of residual renal function (P<0.01). Serum albumin decreased with time on PD (P = 0.02). A rise in small solute transport and a decrease in net ultrafiltration, but no change in protein clearances, were also observed after 2 years of PD. CONCLUSIONS: Transport properties across the PM, as evaluated by MTAC creatinine and sodium sieving determinations, are correlated with anthropometric characteristics (BSA) and by comorbid conditions (witnessed by the presence of diabetes, a low serum albumin concentration and the prescription of an ACE inhibitor). The short-term evolution (2 years) of the PM transport properties of patients on APD and icodextrin is still characterized by a progressive increase in small solute transport and a loss of ultrafiltration capacity, as documented in ancient studies, but not with a modification in protein clearances. This conclusion merits, however, to be further evaluated in a larger cohort of PD patients after a longer follow-up.

Angiotensin-Converting Enzyme Inhibitors↗