Thread by @NamrataYParikh

Happy #WorldKidneyDay!
We had a brilliant #NephJC discussion on ISPD 2020 recommendations yesterday!
To commemorate this day, here's a small compilation of some important PD studies -

On solute and fluid clearance -

CANUSA
CANUSA Re-analysis
ADEMEX
HONGKONG TRIAL
EAPOS
NECOSAD 2
NECOSAD

CCr = creatinine clearance
pCCr = peritoneal creatinine clearance

CANUSA ⏩ 0.1🔽Kt/V ➡️6%🔼RR of death
5L/wk 🔽 CCr ➡️ 7% 🔼RR of death
◼️ Gave target weekly Kt/V = 2.1 and CCr = 70L/wk
❗ ASSUMED pCCr = Residual kidney CCr

ncbi.nlm.nih.gov/pubmed/8785388

CANUSA Re-analysis ⏩ Took residual kidney function into consideration
◼️ pCCr ➡️NO INFLUENCE on survival
◼️ 250 mL/day🔼urine output ➡️36%🔽RR of death

ncbi.nlm.nih.gov/pubmed/11562415

ADEMEX ⏩ 4 X 2L exchanges/day 🆚 multiple 2.5-3L exchanges to achieve target pCCr <60L/wk/1.73m2
◼️pCCr ➡️NO INFLUENCE on survival

ncbi.nlm.nih.gov/pubmed/11961019

HONGKONG TRIAL ⏩ Randomised patients to three Kt/V targets 1️⃣ 1.5-1.7
2️⃣ 1.7 -2.0
3️⃣ >2.0
◼️ Kt/V ➡️NO INFLUENCE on survival

ncbi.nlm.nih.gov/pubmed/12846762

EAPOS ⏩ To study feasibility of APD in anuric patients ⏩ Aimed for CCr >= 60L/wk/1.73m2 and UF >= 750 mL/24 hrs
◼️ CCr ➡️ NO EFFECT on survival
◼️ Baseline UF ➡️ Associated with survival

ncbi.nlm.nih.gov/m/pubmed/14569…

NECOSAD 2 ⏩ longitudinal analysis of patients treated with 3 months PD
◼️ Higher pCCr ➡️ NO EFFECT on survival
◼️ 1mL/min/1.73m2 🔼 GFR ➡️ 12% 🔽 mortality

ncbi.nlm.nih.gov/m/pubmed/12776…

NECOSAD ⏩ Prospective study of anuric PD patients over 2 years
◼️ Kt/V < 1.5/wk and pCCr <40L/wk/1.73m2 ➡️ 🔼RR of death
◼️ UF ➡️ 🔼survival

ncbi.nlm.nih.gov/m/pubmed/16105…

On PD solutions -

MIDAS
balANZ
IMPENDIA/EDEN

MIDAS ⏩ Overnight icodextrin 🆚 dextrose based solutions
◼️ Icodextrin ➡️ safe, effective ⏩ can replace dextrose based solutions

ncbi.nlm.nih.gov/m/pubmed/79673…

balANZ ⏩ neutral pH, low GDP dialysate 🆚 conventional dialysate
Biocompatible solutions ➡️ NO role in GFR decline BUT
◼️ May delay anuria
◼️ 🔽Peritonitis

ncbi.nlm.nih.gov/pmc/articles/P…

IMPENDIA/EDEN ⏩ dextrose solutions 🆚 low glucose intervention group (dextrose based solution + icodextrin + amino acids)
Glucose sparing protocol ➡️
◼️ Improved metabolic indices BUT
◼️ 🔼Risk of ECFV expansion

ncbi.nlm.nih.gov/m/pubmed/23949…

Go ahead and add any more that you are aware of #Nephtwitter

Closing image - I hope it's accurate. Correct me if wrong