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At least 127 records · Page 7Linked to original sources
PubMed2001

Microbiological aspects of peritonitis in patients undergoing chronic peritoneal dialysis at the dialysis unit of Sri Jayawardenapura General Hospital.

BACKGROUND: Peritoneal dialysis (PD) is an established form of therapy in the management of end stage renal disease. Peritonitis is the main complication of PD. OBJECTIVES: To study the incidence and microbial aetiology of peritonitis in patients undergoing chronic PD at the dialysis unit of Sri Jayewardenapura General Hospital (SJGH); to assess the diagnostic value of the Gram's stain; and to study the relationship of the total white cell count of effluent to peritonitis. DESIGN: A prospective study over three months. SETTING: Dialysis unit of SJGH. PATIENT POPULATION: The study involved 18 patients undergoing manual intermittent peritoneal dialysis (IPD), 4 patients undergoing chronic ambulatory peritoneal dialysis (CAPD), and 1 patient undergoing nocturnal intermittent peritoneal dialysis (NIPD). MEASUREMENTS: Clinical presentation of patients with peritonitis; total and differential white blood cell counts of effluent samples; Gram stain and culture of the centrifuged deposit to determine microbial aetiology; incidence of peritonitis in different categories of dialysis. RESULTS: 32 samples were examined from patients on IPD, and 17 from patients on CAPD. In IPD most episodes were due to Gram negative organisms whereas in CAPD most episodes were due to Gram positive organisms. Sensitivity of Gram's stain in relation to culture was 32.4%. 98% of effluent samples had white blood cell counts of > 100/ml and none showed neutrophil counts of < 49%. CONCLUSIONS: The incidence of IPD associated peritonitis was 11.1 episodes per patient year, and the incidence of CAPD associated peritonitis was 14 episodes per patient year. Flavobacterium spp. were the predominant organisms in IPD associated peritonitis, whereas CAPD associated peritonitis was commonly caused by coagulase negative staphylococci. Gram's stain was not useful in the initial identification of the causative agent, but the white cell and neutrophil counts were found to be sensitive indicators of peritonitis.

Humans↗
PubMed2002

[The effect of recombinant human growth hormone on urea and creatinine kinetics and selected dialysis adequacy parameters in children with end-stage renal failure treated with peritoneal dialysis].

UNLABELLED: The aim of this work was to assess the effect of recombinant human growth hormone (rhGH) on the kinetics of urea and creatinine and selected indices of dialysis adequacy in children with end-stage renal failure treated with peritoneal dialysis. We studied 24 children on peritoneal dialysis, including 10 children aged 9-15.7 years (mean age 12.5 years) treated with 1-1.1 IU/kg/week of rhGH administered daily for 6 months. The control group included 14 patients aged 5.4-18.3 years (mean age 12.6 years). Kinetic modelling of urea and creatinine using Adequest was performed in all patients at baseline and after 3 and 6 months of follow-up. Total dialysate and urinary excretion of urea and creatinine (tUE and tCE, mg/min), total urea and creatinine clearance (tUC and tCC, L/week), weekly Kt/V, normalized total weekly creatinine clearance (ntCC, L/week/1.73 m2), total body water (TBW, kg), and absolute and percent change of TBW (DTBW, kg, and D%TBW, respectively) were calculated. Albumin level was measured and diet composition was analysed in all patients. Insignificant decrease in Kt/V was found after 3 and 6 months of rhGH treatment despite stable values of tUC (45.3 +/- 15 L/week vs 45.6 +/- 15 L/week, p = NS). Serum creatinine increased from 7.38 +/- 1.52 to 9.26 +/- 2.98 mg/dL after 6 months of rhGH treatment. Significantly higher values of delta %TBW were found among treated patients compared to the control group (1.23 +/- 0.7 kh vs 0.57 +/- 0.7 kg, P < 0.05). delta TBW in patients treated with rhGH was significantly higher during months 0-3 compared to months 3-6 (0.85 +/- 0.6 kg and 0.38 +/- 0.17 kg, respectively, p < 0.05). No significant changes in ntCC, albumin concentration and diet composition were found. CONCLUSIONS: 1. A trend to lower urea values in children treated with peritoneal dialysis was found after 3 months of rhGH treatment. Concomitant decrease in Kt/V may have resulted from increased TBW. 2. An increase in creatinine level was observed during rhGH treatment in children treated with peritoneal dialysis. Decrease in normalized total creatinine clearance (ntCC) and normalized dialysate creatinine clearance (ndCC) during rhGH treatment may have resulted from increased serum creatinine and not from decreased creatinine excretion. 3. Treatment with rhGH in children on peritoneal dialysis makes it difficult to interpret commonly used indices of dialysis adequacy such as Kt/V and ntCC.

Adolescent↗
PubMedDate not supplied

Selected growth factors in peritoneal dialysis: their relationship to markers of inflammation, dialysis adequacy, residual renal function, and peritoneal membrane transport.

OBJECTIVES: Markers of chronic inflammation, acute-phase reactants, and growth factors may be concomitantly involved in a number of pathologic processes in the general population and uremic patients. In addition, growth factors may influence peritoneal membrane transport characteristics. However, the association between plasma growth factors, markers of chronic inflammation, and peritoneal membrane transport remains largely unknown. The aim of this study was to evaluate the relationship between plasma levels of selected growth factors [basic fibroblast growth factor (bFGF), transforming growth factor beta1 (TGFbeta1), vascular endothelial growth factor (VEGF)] and markers of chronic inflammation [interleukin (IL)-6, C-reactive protein (CRP), and fibrinogen] in continuous ambulatory peritoneal dialysis (CAPD) patients. The potential link between the above substances and dialysis adequacy was also explored. DESIGN: Single-center, cross-sectional study. SETTING: Peritoneal Dialysis Unit, Medical Faculty, Jagiellonian University Hospital, Kraków, Poland. PATIENTS: 32 stable end-stage renal disease patients (13 M, 19 F; mean age 53.6 +/- 13.7 years) on CAPD for a median period of 19.5 months. Patients free from signs and symptoms of any inflammatory disease (including peritonitis) for at least 3 months were included into the study. All patients underwent measurements of dialysis dose [Kt/V, weekly creatinine clearance (wCCr)] and peritoneal solute transport using a standard peritoneal equilibration test (PET). METHODS: TGFbeta1, bFGF, VEGF, and IL-6 were measured with ELISA, CRP was assayed with immunonephelometry, and fibrinogen with Multifibren U reagent (Dade Behring Marburg GmbH, Marburg, Germany). Nephron 97 for Windows software was used to assess dialysis adequacy. RESULTS: Significant positive correlations between plasma bFGF and IL-6, as well as fibrinogen concentrations (R = 0.36, p < 0.05 and R = 0.39, p < 0.05, respectively), were found. VEGF correlated significantly with IL-6 and CRP (R = 0.65, p < 0.0001 and R = 0.51, p < 0.005, respectively). An association between VEGF and bFGF was also found (R = 0.59, p < 0.0005). Serum level of TGFbeta1 revealed no relationship with any marker of acute-phase activation, remaining growth factors, or dialysis adequacy. Positive correlation between TGFbeta1 concentration and dialysate-to-plasma ratio for creatinine in PET (R = 0.35, p < 0.05) was found. In addition, patients with lower solute transport (low/low-average transporters) had lower serum levels of both bFGF and TGFbeta1 compared to patients with higher solute transport. Patients with total wCCr > 60 L/ week/m2 were characterized by lower levels of bFGF and IL-6. Serum level of IL-6 and plasma levels of bFGF and VEGF were significantly lower among subjects with residual renal function (RRF) > 2.0 mL/minute. CONCLUSIONS: Our results indicate that systemic inflammation in peritoneal dialysis patients is associated with increased plasma VEGF and bFGF but not TGFbeta1. The negative correlation with RRF suggests that either the renal clearance of these cytokines and growth factors may contribute to their elimination, or cytokines and growth factors have a negative impact on RRF. We also suggest an association between serum levels of growth factors tested and peritoneal membrane function.

Adult↗
PubMed2005

From adequate to optimal dialysis long 3 x 8 hr dialysis: a reasonable compromise.

Long dialysis (3 x 8 hours/week) has been used in Tassin for three decades now, without method modifications. Results have been excellent considering both morbidity and mortality. Best survival compared to short dialysis is mainly due to low cardiovascular mortality. It is probably due to a good control of arterial hypertension, without antihypertensive medication, and the low rate of intradialytic hypotension. Slow ultrafiltration, allowed by the extended dialysis session, associated with a low-salt diet and a moderate interdialysis weight gain, tend to normalize extracellular volume and ensure normotension. Long hemodialysis assure a good dialysis dose in terms of small and even middle molecules, with good nutrition, anemia correction, phosphate and potassium control with few drugs. Optimal dialysis needs several conditions, each of them necessary. Time seems a central factor, providing a high treatment safety margin. While it is quite difficult to achieve excellent dialysis results with short sessions, long-dialysis is easy to perform with high reliability.

Adult↗
PubMed1994

The production of dialysis by for-profit versus not-for-profit freestanding renal dialysis facilities.

OBJECTIVE: A study was conducted to determine whether for-profit and not-for-profit freestanding renal dialysis facilities differ with respect to efficiency in the production of dialysis treatments. DATA SOURCES/STUDY SETTING: National data on 1,224 Medicare-certified freestanding dialysis facilities were obtained from the Health Care Financing Administration's (HCFA) 1990 Independent Renal Dialysis Facility Cost Report. Data on Medicare patients receiving care at these facilities during 1990 were obtained from HCFA's End Stage Renal Disease (ESRD) Program Management and Medical Information System (PMMIS). STUDY DESIGN: Ordinary least squares regression (OLS) was used to estimate the association between monthly output of dialysis treatments in 1990 and (a) facility capital and labor inputs, (b) facility ownership characteristics, and (c) case-mix characteristics. DATA COLLECTION/EXTRACTION METHODS: Facility and patient level data were extracted from the Facility Cost Report and the PMMIS databases, respectively. Patient level data were aggregated by facility and merged with facility level data. PRINCIPAL FINDINGS: For-profit sole proprietorships, for-profit partnerships and for-profit corporations each produced significantly more dialysis treatments per month than not-for-profits, adjusting for quantities of resource inputs and case-mix characteristics. CONCLUSION: For-profit facilities appear to be more efficient producers of dialysis treatments than not-for-profits. Further study should address whether other factors such as differences in severity of disease or in quality of care are responsible for these observations.

Ambulatory Care Facilities↗
PubMed1995

Nutritional effects of KT/V in children on peritoneal dialysis: are there benefits from larger dialysis doses?

Dialysis adequacy is monitored by urea kinetic modeling (UKM), in particular by calculation of KT/V (normalized whole body urea clearance) and PCRN (normalized protein catabolic rate). All children on peritoneal dialysis from our unit (7 children; mean age 7 years, 8 months) participated in our study (dialysis research program of the French Registry of Peritoneal Dialysis). Every month analysis of dialysate and urine collections and blood samples were compared to a 3-day diet survey to analyze the relations between doses of dialysis (KT/V) and nutrition [dietary protein intake (DPI) and caloric intake]. Calculated protein intake and DPI were also compared. Spearman correlation coefficients were used to assess the association between variables. KT/V values were spread over a wide range (0.8-2.8, mean 1.9). KT/V was positively (weakly) correlated to PCRN (p = 0.07, y = 0.24x + 1.08, r = 0.2), but not to DPI. No correlation could be found between PCRN and DPI, but doses of dialysis (KT/V) were positively correlated to caloric intake (p = 0.001, y = 28.97x + 13.66, r = 0.424). We assume that the correlation between KT/V and PCRN is not necessarily the reason, but only a calculation effect. On the contrary, the positive correlation between KT/V and caloric intake allows us to speculate that more efficient dialysis enhances appetite.

Child↗
PubMed1998

Rapid growth in the use of automated peritoneal dialysis (APD) in adult patients on peritoneal dialysis.

Inadequate dialysis dose is associated with poor patient-survival in peritoneal dialysis (PD). Most patients would require more than four exchanges a day after losing residual renal function. The use of automated peritoneal dialysis (APD) seems to be a practical way to provide extra dialysis for these patients. In our Dialysis Centre in Northern Alberta, we started to use APD for our adult patients only from 1993. When we evaluated our practice recently, we found that we are progressively increasing the use of APD (including cyclers and night exchange devices) from 3% to 21% for our total adult PD patients in the last 3 years. This increase in the use of APD is mostly to accommodate PD prescription changes and not changes in lifestyle. Increase in the use of APD was associated with decrease in the rate of our PD dropout to hemodialysis. We conclude that to maintain adequate dialysis, rapid growth of APD will become common in North American PD centers in the future and will reduce transfer to hemodialysis.

Adult↗
PubMed2005

Dialysis adequacy indices for peritoneal dialysis and hemodialysis.

Dialysis adequacy indices that may be used to evaluate the efficiency of small-solute removal include Kt/V, fractional solute removal (FSR), and equivalent urea clearance (EKR). To analyze possible relationships between those indices, we used the two-compartment variable-volume urea kinetic model to simulate several dialysis modalities: hemodialysis (HD) performed three times or six times weekly, automatic nightly peritoneal dialysis (PD), and continuous ambulatory PD. Instead of targeting a chosen Kt/V value, we selected a weekly FSR of 1.81 as the target adequacy index. We determined hemodialyzer clearances and diffusive mass transport parameters for the peritoneal membrane that yielded the desired value of FSR for a typical patient and dialysis schedule. By theoretic analysis, EKR and FSR are proportional: EKR/FSR = V/Tc, where V = urea distribution volume in the body and Tc = time of the dialysis cycle, usually 1 week. Thus, FSR and EKR have the same meaning and scaling in PD and HD, and may be equivalently applied for assessment of dialysis efficacy.

Computer Simulation↗
PubMed1996

The economic cost of dialysis: a comparison between peritoneal dialysis and in-center hemodialysis in a Spanish unit.

We have studied the economic cost of dialysis therapy in our area (public setting) during 1994, comparing the cost of different modalities of in-center hemodialysis (HD) and home peritoneal dialysis (PD). Analyzed costs included: personnel, drug expenditure, disposable (dialysis- and non-dialysis-related), laboratory, other services, indirect costs, maintenance and redemption, hospital admissions, transport, and home supplies. The final cost per patient and year (in 1994 US$) was: hemodiafiltration (AN69 filter, bicarbonate buffer) $58,890; HD polymethylmethacrylate filter and bicarbonate buffer $55,076; HD cuprophane and acetate buffer $49,767; CAPD $31,201; and cost of automated PD $42,519. The main expenditure sections were: home supply and hospital admissions for PD patients, and personnel, drug expenditures, disposable dialysis material, indirect costs, hospital admissions, and transport for HD patients. Home peritoneal dialysis therapy has a significantly lower economic cost than any in-center HD modality.

Adult↗
PubMedDate not supplied

Effect of dialysis modality and membrane transport characteristics on dialysate protein losses of patients on peritoneal dialysis.

OBJECTIVE: To determine if peritoneal dialysis modality has an impact on protein losses in dialysate. DESIGN: Retrospective, cross-sectional study. PATIENTS: 190 patients who had selected peritoneal dialysis were classified into one of four transport categories (high, high-average, low-average, or low) based on standard peritoneal equilibration test results. Patients were then assigned to continuous ambulatory peritoneal dialysis (CAPD) or nightly intermittent peritoneal dialysis (NIPD) based on membrane transport characteristics and individual preferences. RESULTS: Patients with similar membrane transport characteristics had essentially no differences in dialysate protein and albumin losses whether treated with CAPD or NIPD. CONCLUSIONS: Although high transporters may be better managed with short-dwell therapies such as nocturnal intermittent peritoneal dialysis or daily ambulatory peritoneal dialysis, consistent marked decreases in protein losses cannot be cited as a benefit of NIPD over CAPD.

Biological Transport, Active↗
PubMed1981

Conditions for coverage of suppliers of ESRD services self-dialysis and home dialysis training--Health Care Financing Administration. Notice of proposed rulemaking.

These proposed regulations will provide for program approval of a facility that furnishes training and support services for self-dialysis and/or home dialysis, either as the only service or in combination with self-dialysis services. The requirements for a training facility are the same as those for facilities furnishing staff-assisted dialysis, with some additional specific training requirements. The intent of this change is to encourage greater use of self-dialysis. Other changes are being made to facilitate program administration, and to respond to comments on the regulations implementing the 1978 amendments, as well as to adapt the requirements to a recently developed treatment technique known as continuous ambulatory peritoneal dialysis (CAPD), to provide for approval of special purpose renal dialysis facilities, and to require open staffs in ESRD facilities.

Health Facilities↗
PubMed1977

Principles of dialysis and dialysis of drugs.

Consideration of the interactions of drugs and dialysis must include an understanding of the mechanisms of transport during dialysis, i.e., diffusion, ultrafiltration and membrane-protein binding effects. Clearance is a function of molecular size, blood and dialysate flow, membrane area and permeability, and dialyzer support geometry. Protein binding and hematocrit decrease the in vivo clearances in comparison to those measured in vitro with aqueous solutions. The effect on the serum half-life is also determined by the distribution space and clearance by other routes. Other factors such as metabolic alterations of dialysis can affect pharmacologic activity, and the clinical response is the end product of many determinants. Numerous drugs are effectively removed by hemodialysis or at a slower rate by peritoneal dialysis, which occasionally allows considerable influx. The influence of intestinal contents on elimination rates by peritoneal dialysis is unknown. Peritoneal dialysis can be influenced considerably by vasoactive drugs.

Animals↗
PubMed1988

Quality of life in chronic dialysis patients. Factors unrelated to dialysis modality.

The quality of life (medical, psychological, and social adaptation) of 66 chronic dialysis patients was studied cross-sectionally. The participants had similar levels of medical, psychological, and social adaptation to those found in previous studies of chronic dialysis patients. Medical, psychological, and social adaptation are independent dimensions that are only weakly intercorrelated. When categorized by specific individual or treatment characteristics, men and those over age 51 had poorer medical and psychological adaptation than did women and younger dialysis patients. Duration of dialysis was not related to quality of life. Vocationally active as compared to vocationally inactive subjects had generally superior medical, psychological, and social adaptation. Male sex, age over 51, and vocational inactivity are all associated with poorer dialysis patient adaptation. The development of profiles of groups of dialysis patients at increased risk for poor adaptation may help in targetting scarce psychosocial intervention resources. Studies of the psychosocial efficacy of differing treatment modalities need to consider non--treatment-related factors that may affect patient psychosocial outcomes.

Adjustment Disorders↗
PubMed1996

Staphylococcus aureus carriage and infections among patients in four haemo- and peritoneal-dialysis centres in Denmark. The Danish Study Group of Peritonitis in Dialysis (DASPID).

A three-month prospective surveillance study was undertaken in four dialysis centres to establish the prevalence of Staphylococcus aureus carriage in a Danish population of patients on haemodialysis (HD) or on continuous ambulatory peritoneal dialysis (CAPD). General data such as sex, age, diagnosis, number of months in dialysis, hospital and ward were registered on a precoded form. Standardized nose and four skin swabs (axillae, groins, perineum) were performed on the first day of the survey. After one and two months, nose swabs were collected. Infections were registered and cultures were sent for phage-typing together with the S. aureus strains isolated from the swabs; 59.5% of HD patients and 51.2% of CAPD patients carried S. aureus. Permanent carriage was most frequent (P < 0.00009), primarily in the nose (44.0 and 34.9%, respectively in HD and CAPD). Skin carriage alone was rare (2.4 and 4.7%). Approximately one third (36.6 and 40.7%) of infections were caused by S. aureus. Although diabetics were not significantly more frequent carriers (60.5%) than non-diabetics (55.0%), the incidence of infection was much higher (26.3% vs. 10.3%, P = 0.004). In CAPD, peritonitis and tunnel/exit-site infections predominated (81.4%), often caused by S. aureus (34.8%). More than two thirds of the infections in HD patients were related to intravascular catheterization. The most serious infection was septicaemia, in all cases due to S. aureus. S aureus infections occurred significantly more frequently among carriers (P = 0.005), and more than half the patients were infected by the same or possibly the same strain as they carried in the nose or on skin. Different regimens for the elimination of S. aureus carriage in dialysis patients are discussed. A policy for risk assessment of patients should be developed, and the elimination of S. aureus carriage before dialysis should be encouraged. Controlled trials comparing the cost-effectiveness of recommended regimens to eliminate carriage in HD/CAPD patients are needed. Nose swabs are reliable indicators of carriage in dialysis patients.

Carrier State↗
PubMed1994

Adequacy of continuous ambulatory peritoneal dialysis: morbidity and mortality in chronic peritoneal dialysis.

Mortality for hemodialysis patients tends to be in excess of 20% per year, and it is generally agreed that outcome for continuous ambulatory peritoneal dialysis patients is comparable. Several investigators have suggested recently that continuous ambulatory peritoneal dialysis, as commonly practiced, may not provide adequate therapy, especially for larger patients and for those with no residual renal function. Unfortunately, a dose-response curve relating the amount of dialysis delivered and clinical outcome for continuous ambulatory peritoneal dialysis patients has not been constructed. Several methods of quantifying the dose of peritoneal dialysis are described. Both cross-sectional and longitudinal studies are reviewed. The conclusions of these studies are of limited value, however, because of their retrospective nature and the limited number of patients enrolled. Nevertheless, in aggregate, these studies suggest that survival may be improved by higher doses of dialysis. They also suggest that while malnutrition is relatively common in this patient population, higher doses of Kt/V are associated with higher protein intake (as measured by protein catabolic rate). Serum albumin is recognized as a strong predictor of clinical outcome and the protein catabolic rate may correlate directly with Kt/V, but there are studies that support and others that refute a correlation between Kt/V and serum albumin. Definitive answers to these questions are likely to be available in the near future. Two large multicenter studies are currently under way. Preliminary results may be available in the near future.

Blood Urea Nitrogen↗
PubMed1984

Experience with intermittent peritoneal dialysis and continuous cyclic peritoneal dialysis.

Acceptance of peritoneal dialysis as a standard modality of therapy for end-stage renal disease (ESRD) was initially slow due to various technical problems and the difficulty of quantitating peritoneal membrane function. Development of reliable, permanent access to the peritoneum and the availability of dependable automated equipment stimulated the development of intermittent peritoneal dialysis (IPD), which demonstrated initial success. However, the failure rate was noted to increase with time, primarily due to insufficient dialysis and malnutrition. The introduction of continuous ambulatory peritoneal dialysis (CAPD) allowed better clearances and the maintenance of a more physiologic steady state. However, the twin problems of inconvenience and frequent infections proved to be significant. Continuous cyclic peritoneal dialysis (CCPD) was then developed to allow exchanges at night on a more convenient basis, reduce the rate of peritonitis by circumventing some of the technical disadvantages of CAPD, and decrease the stress on any helpers who may be involved. Experience with CCPD has demonstrated acceptable control of nitrogenous waste products, fluid balance, adequate maintenance of nutrition in the great majority of patients, and satisfactory maintenance of hemoglobin and acid-base balance. CCPD also offers flexibility of prescription accomplished by varying the frequency and length of nocturnal automated cycles. The preliminary experience with peritoneal kinetic modeling suggests that quantitation of peritoneal function will be significantly improved in the future and that standards of adequacy of dialysis will be more precisely defined.

Bacterial Infections↗
PubMed1988

Quality of life in chronic dialysis patients: a critical comparison of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis.

Thirty-three matched pairs of chronic continuous ambulatory peritoneal dialysis (CAPD) and center hemodialysis (CHD) patients from three dialysis programs were studied cross-sectionally to assess their current medical, psychological, and social status. The CAPD and CHD groups were similar on matching and medical status variables. The CAPD subject group had a higher quality of life, lower illness and modality related stress scores, and nonsignificantly lower mood disturbance scores. The groups did not differ in self-esteem or health locus of control. CAPD subjects reported higher frequency of participation in community activities, better relationships with dialysis physicians and patients, and were more likely to be currently vocationally active. Dialysis modality likely exerts an independent effect on the quality of life of chronic dialysis patients, and CAPD is likely superior to CHD in this regard. Longitudinal studies are needed to determine the relative role of patient-selection and modality-related factors in determining the psychological and social adaptation (quality of life) of chronic dialysis patients.

Activities of Daily Living↗
PubMed1988

Relationship of dialysis modality and other factors to cognitive function in chronic dialysis patients.

To determine if dialysis modality may be an independent factor in the level of cognitive function in chronic dialysis patients, cognitive function was studied in 17 pairs of continuous ambulatory peritoneal dialysis (CAPD) and center hemodialysis (CHD) subjects matched for sex, age, diabetic status, and interval since dialysis onset. Data on current metabolic, medical, psychological, and vocational function status were obtained. Neuropsychological (NP) measures included the Number Cancellation Protocol (NCP), Trailmaking test forms A and B (TMT A, TMT B), Symbol Digit Modalities (SDM), and the Rey Auditory Verbal Learning Test (RAVLT). The CAPD subject group had consistently more efficient cognitive function than the CHD subject group. Regardless of modality, the groups of subjects under age 51 and those who were vocationally active had significantly better NP performance. No cognitive function differences were found in groups categorized by sex or duration of dialysis. Creatinine levels were more highly correlated with NP scores than were BUN levels, with higher creatinine levels associated with better cognitive function. Serum calcium, CO2, total protein, albumin, and SGOT levels also were correlated with NP scores. CAPD may be more effective than HD in reversing uremic encephalopathy by mechanisms mostly unrelated to serum creatinine and BUN levels. Longitudinal studies will be needed to determine if dialysis modality is an independent factor in the degree of reversal of uremic encephalopathy.

Adult↗