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. 2011 Mar;6(3):561-6.
doi: 10.2215/CJN.05540610. Epub 2010 Nov 11.

Peritoneal albumin and protein losses do not predict outcome in peritoneal dialysis patients

Olga Balafa  1 , Nynke Halbesma, Dirk G Struijk, Friedo W Dekker, Raymond T Krediet
Affiliations

Peritoneal albumin and protein losses do not predict outcome in peritoneal dialysis patients

Olga Balafa et al. Clin J Am Soc Nephrol. 2011 Mar.

Abstract

Background and objectives: Peritoneal clearance of albumin-unlike the transport of small molecules-is defined by both vascular surface area and size-selective permeability. Few studies have supported a positive correlation between peritoneal albumin loss and mortality. The aim of this study was to investigate whether baseline peritoneal loss and clearance of albumin and other proteins is a risk factor of death in peritoneal dialysis patients.

Design, setting, participants, & measurements: All incident peritoneal dialysis patients in our center during the last 15 years were included. Mass-transfer area coefficient of creatinine and peritoneal clearances of albumin, β₂-microglobulin, α₂-macroglobulin, and immunoglobulin G were calculated during a standard peritoneal permeability analysis. The total amount of albumin loss in the dialysate was also calculated. Overall mortality was studied with an intention-to-treat analysis.

Results: Two hundred fifty-seven patients were included. High baseline albumin clearance was associated with fast transport status, the presence of peripheral arterial disease, and a high comorbidity index, whereas C-reactive protein levels did not differ from the patients with low albumin clearance. Age, high comorbidity score, C-reactive protein levels >10 mg/L, and a low serum albumin were associated with mortality. Peritoneal albumin clearances and albumin loss were not associated with death in crude and adjusted analysis. Similarly, peritoneal clearances of immunoglobulin G, α₂-macroglobulin, and β₂-microglobulin were not determinants of survival.

Conclusions: Baseline peritoneal albumin and protein clearances are associated with signs of comorbidity, but this does not have a measurable effect on patient survival.

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Figures

Figure 1.
Figure 1.
Kaplan-Meier survival curves for patients with low and high peritoneal clearance of albumin (A) and albumin loss (B) (intention-to-treat analysis). The number of patients at risk is given below the horizontal axis. The difference between the two groups was not significant (log rank test, P = 0.51 and 0.69, respectively).
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