Survival comparison between hemodialysis and peritoneal dialysis based on matched doses of delivered therapy.

Several studies have recently confirmed that hemodialysis (HD) and continuous ambulatory peritoneal dialysis (CAPD) survival is highly associated with delivered therapy Kt/V(urea). A direct comparison of equivalently dosed CAPD and HD has not previously been performed. A total of 968 incident HD patients at the Regional Kidney Disease Program from 1987 to June 1995 were studied, and these results were compared with those of the Canadian-United States prospective trial (CANUSA) consisting of 680 incident CAPD patients from September 1990 to December 31, 1992, with follow-up through December 31, 1993.

Resource limitations and strategies for the treatment of uremia. A dialysis unit in the Himalayan foothills.

India has made great strides in health care since gaining independence in 1947. Much still needs to be done. Scarce health care resources are directed at priorities that include infant and maternal mortality, immunizations, malnutrition, communicable disease prevention, and access to protected water and sanitation.

Timely initiation of dialysis: a urea kinetic approach.

The traditional approach of initiating dialysis when the patient begins to manifest uremic symptoms may result in the development of significant malnutrition with detrimental effects on subsequent morbidity and mortality. The recently issued Dialysis Outcome Quality Initiative guidelines suggest that dialysis be initiated when the Kt/V from residual renal function decreases to less than 2.0.

Imprecision of the hemodialysis dose when measured directly from urea removal. Hemodialysis Study Group.

Background: The postdialysis blood urea nitrogen (BUN; Ct) is a pivotal parameter for assessing hemodialysis adequacy by conventional blood-side methods, but Ct is relatively unstable because of hemodialysis-induced disequilibrium. The uncertainty associated with this method is potentially reduced or eliminated by measuring urea removed on the dialysate side, a more direct approach that can determine adequacy from the fraction of urea removed and by substituting an estimate of the equilibrated postdialysis BUN (Ceq) for Ct. For a patient with a known urea volume (V), Ceq, the equilibrated Kt/V (eKt/V), and the solute removal index (SRI) can be calculated from the predialysis BUN (C0), total urea nitrogen removed (A), and V from simple mass balance calculations (dialysate/volume method).

Increased peritoneal membrane transport is associated with decreased patient and technique survival for continuous peritoneal dialysis patients. The Canada-USA (CANUSA) Peritoneal Dialysis Study Group.

The objective of this study was to evaluate the association of peritoneal membrane transport with technique and patient survival. In the Canada-USA prospective cohort study of adequacy of continuous ambulatory peritoneal dialysis (CAPD), a peritoneal equilibrium test (PET) was performed approximately 1 mo after initiation of dialysis; patients were defined as high (H), high average (HA), low average (LA), and low (L) transporters. The Cox proportional hazards method evaluated the association of technique and patient survival with independent variables (demographic and clinical variables, nutrition, adequacy, and transport status).