Longitudinal membrane function in functionally anuric patients treated with APD: Data from EAPOS on the effects of glucose and icodextrin prescription

Longitudinal membrane function in functionally anuric patients treated with APD: Data from EAPOS on the effects of glucose and icodextrin prescription. Background: Peritoneal dialysis is associated with changes in membrane function that can lead eventually to ultrafiltra- tion (UF) failure. Factors driving these changes are thought to include hypertonic glucose exposure, but previously reported associations are confounded by the presence of residual renal function. Methods: Longitudinal membrane function (solute trans- port and UF capacity) were measured annually in a prospec- tive cohort of 177 functionally anuric patients as part of the European Automated Peritoneal Dialysis Outcomes Study (EAPOS). Subgroup analysis was performed according to glu- cose exposure and icodextrin use at baseline. Results :T he whole cohort experienced an increase in solute transport and reduction in UF capacity at 12 and 24 months that could not be explained by informative censoring. These changes were accelerated and more severe in patients using either 2.27% or 3.86% glucose, or those not using icodextrin at baseline. These differences could not be explained by age, comorbidity score, previous time spent on renal replacement, differential dropout from the study, peritonitis rates, or, by defi- nition, residual renal function. Patients using icodextrin at base- line had worse membrane function and were more likely to be diabetic. There was an association between membrane function changes and achieved 24-hour ultrafiltration over the 2-year study period. Conclusion: Anuric automated peritoneal dialysis (APD) pa- tients experience significant detrimental changes in membrane function over a relatively short time period. Glucose appears to enhance these changes independent of residual renal func- Ke yw ords: ultrafiltration, solute transport, observational cohort study, peritonitis.