CAPD Adequacy 2005.doc

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CAPD Adequacy 2005.doc

  1. 1. NORTH WEST RENAL AUDIT PROGRAMME PERITONEAL DIALYSIS ADEQUACY:1999 - 2002 PRELIMINARY REPORT DATE PRINTED: NOVEMBER 2005 AUDIT LEADS: Dr S. Mitra Dr M. Venning SENIOR REGISTRARS: Dr A. Irtiza-Ali Dr B. Pandya AUDIT FACILITATOR L. Palmer Contact Address: NW Renal Audit Programme Clinical Audit Office 1 Floor ERC st Wythenshawe Hospital Southmoor Road M23 9LT Telephone: 0161 291 5821
  2. 2. PD Adequacy Preliminary Report 1999 - 2002 ______________________________________________________________ 1. Introduction Adequate peritoneal dialysis has been a widely debated topic in recent times. The symptoms of inadequate dialysis may range from obviously gross underdialysis culminating in death to patients being totally bored with life and on the verge of depression, weakness, anorexia, weight loss, progressing through malnutrition, pericarditis. A minimalist approach would be to just avoid some of these. What we strive to provide however is optimum dialysis, when we have patients looking good, feeling free of uremic symptoms, hopefully eating well and reasonably active with a good quality of life. At this point we can find that our efforts have culminated in a flattening of the curve beyond which the risk/benefit ratio would be not worth proceeding further. As we analyze adequacy and overall well-being of the patient we employ measures of dialysis as a surrogate to quantify this otherwise largely subjective operational definition. Traditionally one of these parameters of adequacy has been based on measuring clearance of predominantly small uremic solutes i.e urea and creatinine. The Standards Committee of the Renal Association (UK) has identified a number of laboratory and clinical variables that may relate to quality of care or outcomes, and has recommended minimum Standards or target ranges that should be achieved in established dialysis patients. The weekly Kt/V for urea and the weekly creatinine clearance are both used at present as measures of small solute clearance. Each is the sum of the clearance achieved by the dialysis and that due to the residual renl function (RRF). Renal and peritoneal clearance are not equal, although this is assumed when compensating for the loss of RRF by increasing peritoneal clearances. At present the two measures (Kt/V and creatinine clearance) are regarded as being equivalent and either can be used. Creatinine clearance is greatly affected by RRF and declines more as RRF decreases. A weekly Kt/V <1.65 was reported to be associated with poor outcome. Original DOQI guidelines were predicated on the basis of the Maiorca study and the CANUSA study. They demonstrated the best survival when Kt/ V exceeded 1.96. The recently reported ADEMEX study on the other hand is the first randomized, prospective interventional study aimed at assessing whether survival improves with higher Kt/V. It was appropriately designed, and it achieved randomization for age, gender, percent diabetes, hypertension, body surface area, etc. The ADEMEX randomized control trial showed no difference in outcome after two years in patients maintaining a creatinine clearance of 46 litres per week compared with those achieving 57 litres per week. This study therefore provides a firmer evidence base and justifies the minimum target of creatinine clearance of 50 litres per week and a Kt/ V greater than 1.7. A revised Renal Standards document was published in autumn 2002 where dialysis adequacy parameters and their monitoring for creatinine clearance and KT/V were set for CAPD: (>50l/week ; 1.7) respectively based on supportive evidence (level B or C). ____________________________________________________________ November 2005 Page 1
  3. 3. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ 2. Aims and Objectives • To measure achievement of the Renal Association recommendations1 for small solute adequacy • (Total Kt/V and Total Creatinine Clearance) in peritoneal dialysis (PD) patients in the North West Region. • To examine the protocols for PD adequacy testing in all the participating renal units. • To analyse the characteristics of patients failing to achieve the recommended targets for PD adequacy. 3. Renal Association Standards 2002 1 o A total weekly creatinine clearance (dialysis + residual renal function) of greater than 50 l/week/1.73 m2 and/or a weekly dialysis Kt/V urea of greater than 1.7, checked eight weeks after beginning dialysis, are minima. Higher targets are desirable especially for high average and high transporters and APD patients. o These studies (PD adequacy) should be repeated at least annually, and more frequently if clinically indicated, particularly if suspicion arises that residual renal function has declined more rapidly than usual. o At present both Kt/V and creatinine clearance are acceptable measures of adequacy until evidence accumulates to show the superiority of one over the other. Achieving either target is acceptable ; creatinine clearance is more difficult to achieve in anuric patients with below average peritoneal solute transport. 4. Methods • The three audit data sets examined (1999-2000, 2000-2001 and 2001-2002) were taken from PD patients at Salford Royal Hospital (SRH), Royal Liverpool University Hospital (RLH), Manchester Royal Infirmary (MRI) and Royal Preston Hospital (RPH). • Data for the 1999-2000 audit were from all patients who had a PD adequacy test performed between 1st July 1999 and 30th June 2000. Data for the 2000-2001 audit were from all patients who had a PD adequacy test performed between 1st July 2000 and 30th June 2001. Data for the 2001-2002 audit were from all patients who had a PD adequacy test performed between 1st July 2001 and 30th June 2002. ____________________________________________________________ November 2005 Page 2
  4. 4. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ • Data were obtained retrospectively from Adequest, a database used by all units to monitor PD adequacy tests. When patients had more than one test in a year, the most recent was used. A small amount of additional data was collected from medical notes. • Data sets included were under the following main headings:  Patient demographics - Age, gender, weight and ethnic group.  Total Weekly KT/V – Residual and Dialysate Kt/V.  Total Weekly Creatinine clearance - Residual and Dialysate Creatinine Clearance (CCr) (L/Week/1.73sq.m )  Prescribed dialysate volumes & ultrafiltration volumes (mls).  Urine Output (mls) and Residual renal function . 5. RESULTS 5.1 Characteristics of the patient population Gender, age, ethnicity and weight. • Regionally, the percentage of males and mean weight of those PD patients tested has remained constant. The percentage of Caucasians has increased by a small amount from 86% to 89% and the mean age has increased from 53 to 57 years between 1999/2000 and 2001/2002 (Table 1). 99/00Liverpool 00/01Liverpool 01/02Liverpool 99/00Regional 00/01Regional 01/02Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 00/01Hope 01/02Hope 99/00Hope No. of patients tested 125 137 115 47 65 51 83 90 165 73 90 126 328 382 457 % Male 51 44 49 64 58 49 60 69 61 63 64 66 58 57 58 % Caucasian 90 88 90 92 94 96 80 84 88 84 84 86 86 87 89 Age (Mean) 56 57 57 51 48 49 51 50 54 54 57 53 53 52 57 Weight (Mean) 68 68 69 74 76 71 71 72 70 68 69 71 71 70 71 ____________________________________________________________ November 2005 Page 3
  5. 5. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ 99/00Regional 00/01Regional 01/02Regional No Liverpool No. of patients tested 281 316 406 % Male 57 62 59 % Caucasian 85 86 88 Age (Mean) 53 55 55 Weight (Mean) 69 69 72 Table 1: Gender, ethnic group, age and weight of PD patients tested for dialysis adequacy 5.2 PD Modality distribution • There was a large variability in the completeness of the PD modality data. As a result, data broken down by PD mode must be interpreted with caution (Table 2). 00/01Liverpool 01/02Hope 99/00Liverpool 01/02Liverpool 99/00Regional 01/02Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 00/01Hope 00/01Regional 99/00Hope Capd (%) 79 91 77 51 65 70 92 87 63 86 91 89 79 86 74 Apd (%) 3 8 7 17 33 26 2 9 4 11 9 11 7 12 9 Unknown (%) 18 1 16 32 2 4 6 4 33 3 0 0 14 2 16 99/00Regional 00/01Regional 01/02Regional No Liverpool Capd (%) 84 90 75 Apd (5%) 5 8 7 Unknown (%) 11 2 18 Table 2: Distribution of PD modality in patients tested for dialysis adequacy 5.3 Protocols for PD adequacy testing • Throughout the region there were variations in the protocols for PD adequacy testing. SRH had routine yearly tests in 1999. MRI and RPH started yearly tests ____________________________________________________________ November 2005 Page 4
  6. 6. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ during the 3-year audit period. RLH due to limited staff and resources, only performed PD aadequacy tests when clinically indicated. • In this report, it must be acknowledged that the RLH data were taken from a selected population with clinical problems and therefore the RLH data does not wholly represent the RLH PD population. • Regionally, the use of adequacy testing within the PD population has increased steadily between 1999-2002 (Table 3). Throughout the audit period, a high percentage of patients had a PD adequacy test at SRH. MRI and Preston increased testing throughout the audit period. RLH increased the percentage of their PD population tested between 1999 and 2001 but the percentage declined thereafter (Table 3). SRH RLH MRI RPH Region 1999/2000 95 31 44 54 56 2000/2001 98 45 49 68 65 2001/2002 96 36 76 88 74 Table 3: Percentage of patients who had a PD adequacy test 5.4 Small solute adequacy (Total Creatinine clearance ) • Regionally, the percentage of patients achieving a Total CCr > 50 L/week/1.73sq.m remained the same over the 3 year audit period (Table 4). • SRH consistently had the highest percentage of patients achieving a Total CCr >50 L/week/1.73sq.m. RPH, MRI and RLH ranked behind (Table 4). SRH RLH MRI RPH Region Region no Liverpool 1999/2000 92 66 69 85 81 84 2000/2001 95 57 70 91 82 87 2001/2002 93 69 73 90 82 84 Table 4 : Percentage of patients achieving Total CCr > 50 L/week/1.73m2 5.5 Small solute adequacy ( Total KT/V urea ) • Regionally, the percentage of patients achieving a Total Kt/V > 1.7 initially increased and then reached a plateau over the 3 year audit period (Table 5). • Over the 3 year audit period, all units increased the percentage of patients achieving a Total Kt/V > 1.7. SRH consistently had the highest percentage of ____________________________________________________________ November 2005 Page 5
  7. 7. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ patients achieving a Total Kt/V > 1.7. Again RPH, MRI and RLH ranked behind SRH (Table 5). SRH RLH MRI RPH Region Region no Liverpool 1999/2000 86 51 64 74 73 77 2000/2001 90 62 77 90 82 86 2001/2002 90 67 78 87 82 84 Table 5: Percentage of patients achieving Total Kt/v > 1.7 5.6 Small solute adequacy (Total KT/V urea &/or Creatinine clearance) • Regionally the percentage of patients achieving the recommendation Total Kt/V > 1.7 and/or Total CCr > 50 L/week/1.73m2 increased over the 3 year audit period (Table 6). • The percentage of patients achieving either Total Kt/V > 1.7 and/or Total CCr > 50 L/week/1.73m2 over the 3-year audit period increased in all units. SRH started with and maintained the highest level(Table 6) SRH RLH MRI RPH Region Region no Liverpool 1999/2000 94 68 78 88 85 88 2000/2001 98 71 82 92 88 92 2001/2002 95 77 84 94 89 90 Table 6: Percentage of patients achieving Total Kt/V > 1.7 and/or Total CCr >50 L/week/1.73m2 • Regionally in 1999/2000, the percentage of CAPD patients achieving either Total Kt/V > 1.7 and/or Total CCr > 50 L/week/1.73m2 was greater than the percentage of APD patients achieving the Renal Association Recommendation. In 2000/2001 and 2001/2002, this trend reversed (Table 7) CAPD APD CAPD no APD no Liverpool Liverpool 1999/2000 86 82 88 93 2000/2001 88 94 92 89 2001/2002 88 98 90 96 Table 7: Percentage of CAPD/APD patients achieving a Total Kt/V > 1.7 and/or Total CCr >50 L/week/1.73m2 ____________________________________________________________ November 2005 Page 6
  8. 8. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ 5.7 Prescribed dialysate volumes • Regionally, the number of patients with prescribed dialysate volumes less than 8000mls decreased. Those with prescribed dialysate volumes greater than or equal to 8000mls increased . The median levels have remained constant (Table 8). Over the 3year audit period mean prescribed dialysate volumes have increased in all units except Liverpool. 01/02SRH 99/00RPH 99/00Region 00/01Region 01/02Region 00/01SRH 99/00RLH 00/01RLH 01/02RLH 99/00MRI 00/01MRI 01/02MRI 00/01RPH 01/02RPH 99/0SRH ≤6000 (%) 14 13 14 9 5 16 10 9 4 21 20 2 21 12 7 6500-7500 (%) 3 3 3 6 5 6 1 1 2 0 1 12 2 2 5 8000 (%) 59 55 50 51 52 57 68 48 68 53 52 48 51 52 57 ≥ 8000 (%) 24 29 33 34 38 22 21 42 26 26 27 38 26 34 31 Lowest Highest Mean (mls) 8307 8763 8860 9321 9825 8526 8399 9033 8684 8233 8461 8868 8461 8936 8505 Median (mls) 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 No Liverpool 99/00Region 00/01Region 01/02Region ≤6000 (%) 15 14 9 6500-7500 (%) 1 2 2 8000 (%) 60 52 57 ≥ 8000 (%) 24 32 32 Lowest 3000 3000 3000 Highest 2050 2200 21000 0 0 Mean (mls) 8432 8743 8252 Median (mls) 8000 8000 8000 Table 8: Prescribed dialysate volumes (mls) 5.8 PD Ultrafiltration • Regionally over the 3 year audit period, there has been a marginal but insignificant increase in mean and median PD ultrafiltration (Table 9). • Throughout the 3 year audit period, SRH achieved the highest PD ultrafiltrate volumes. PD ultrafiltration had also increased at RLH and MRI . ____________________________________________________________ November 2005 Page 7
  9. 9. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ 99/00Liverpool 00/01Liverpool 01/02Liverpool 99/00Regional 00/01Regional 01/02Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 00/01Hope 01/02Hope 99/00Hope Lowest -700 -800 -100 -800 -700 -400 -1800 -920 -1250 -1200 -1560 -1920 -1800 -1560 -1920 Highest 3600 3900 3500 2800 3600 2500 4000 3850 3850 3200 3260 3550 4000 3900 3850 Mean 1426 1470 1343 766 978 959 757 1152 1026 1037 991 1037 1076 1199 1101 Median 1300 1500 1300 700 1000 1000 800 1005 1100 1100 880 1025 1000 1100 1140 No liverpool 99/00Region 00/01Region 01/02Region Lowest -1800 -1560 -1920 Highest 4000 3900 3850 Mean (mls) 1127 1244 1119 Median (mls) 1080 1200 1195 Table 9: PD ultrafiltration volumes (mls) 5.9 Urine Output • Regionally, over the three-year audit period, there has been a small increase in mean and median urine output (Table 10). Over the three-year audit period, there was an increase in urine output at RPH. Changes at RLH, RPH and SRH were variable. 99/00Liverpool 00/01Liverpool 01/02Liverpool 00/01Hope 01/02Hope 99/00Regional 00/01Regional 01/02Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 99/00Hope Lowest 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Highest 1990 2570 2270 2670 2440 2370 3080 2630 2940 2550 2750 2900 3080 2750 2940 Mean 504 539 473 629 558 721 504 539 473 431 574 751 535 555 627 Median 320 390 320 450 310 560 470 345 400 300 400 550 355 380 420 No liverpool 99/00Region 00/01Region 01/02Region Lowest 0 0 0 Highest 3080 2750 2940 Mean (mls) 520 556 615 Median (mls) 340 400 405 Table 10: Urine output (mls) ____________________________________________________________ November 2005 Page 8
  10. 10. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ 5.10 Residual Renal Function • Regionally, over the 3-year audit period, the percentage of patients with no residual renal function remained unchanged. • Over the three year audit period, RPH tended to have more patients with no residual renal function than other centres. SRH RLH MRI RPH Region Region No Liverpool 1999/2000 27 23 29 45 31 32 2000/2001 24 34 37 36 31 31 2001/2002 26 26 33 36 31 32 Table 11: Percentage of patients with no residual renal function 5.11 Ultrafiltration Volumes • Regionally, mean and median PD ultrafiltration volumes are higher in patients without residual renal function than in patients with residual renal function (Table12 ; table 13). • Regionally, over the 3 year audit period, there was an increase then a decrease in the mean PD ultrafiltration volumes of patients without residual renal function. At each individual unit, they followed the same pattern although overall, they increased at MRI, RLH and RPH and decreased at SRH (Table12). 99/00Liverpool 00/01Liverpool 01/02Liverpool 99/00Regional 00/01Regional 01/02Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 00/01Hope 01/02Hope 99/00Hope Lowest 100 410 -100 260 500 -200 -450 200 -240 -720 190 -130 -720 190 -240 Highest 3500 3900 2200 1400 3600 1700 2650 3850 3850 3200 2700 3500 3500 3900 3850 Mean 1534 1622 1340 780 1354 833 871 1414 1268 1029 1310 1292 1128 1432 1260 Median 1300 1600 1400 600 1170 800 770 1410 1250 1100 1225 1230 1050 1335 1250 No liverpool 99/00Region 00/01Region 01/02Region ____________________________________________________________ November 2005 Page 9
  11. 11. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ Lowest -720 190 -240 Highest 3500 3900 3850 Mean (mls) 1172 1450 1304 Median (mls) 1075 1375 1300 99/00Liverpool 00/01Liverpool 01/02Liverpool 00/01Hope 01/02Hope 99/00Regional 00/01Regional 01/02Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 99/00Hope Lowest -700 -800 -70 -800 -700 -400 -1800 -920 -1250 -1200 -1560 -1920 -1800 -1560 -1920 Highest 3600 3600 3500 2800 2280 2500 4000 3010 2400 2640 3260 3550 4000 3600 3550 Mean 1387 1422 1328 764 785 1002 710 1001 908 1045 816 860 1052 1092 1030 Median 1300 1500 1300 700 900 1000 800 900 920 1090 700 896 1000 1100 1060 No liverpool 99/00Region 00/01Region 01/02Region Table 12: Ultrafiltration volumes (mls) of patients with no residual renal function Lowest -1800 -1560 -1920 Highest 4000 3600 3550 Regionally, over Mean (mls) Median (mls) 1106 1080 1151 1115 1033 1060 • the 3 year audit period, there was little change in the mean PD ultrafiltration volumes of patients with residual renal function (see table14 below). Overall, at MRI and RLH they increased, while at RPH they decreased and at SRH they remained constant (Table 13) . Table 13: PD Ultrafiltration volumes (mls) of patients with residual renal function 5.12 Prescribed Dialysate Volumes • Both regionally and at individual units, throughout the 3 year audit period, the mean prescribed dialysate volumes were higher in patients without renal function, than in patients with renal function (see tables 14 and 15). • Regionally, throughout the 3 year audit period, there was an increase in the mean prescribed dialysate volumes of patients without renal function, and in patients with renal function (Tables 14 and 15). • Throughout the 3 year audit period, there was an increase in the mean prescribed dialysate volumes of patients without renal function and in those ____________________________________________________________ November 2005 Page 10
  12. 12. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ with renal function at MRI, RPH and SRH. At RLH, the mean prescribed dialysate volumes decreased in both groups of patients (Tables 14 and 15). 99/00Liverpool 00/01Liverpool ½Liverpool 99/00Regional 00/01Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 00/01Hope 01/02Hope 01/02Regional 99/00Hope Lowest 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 6000 5800 6000 6000 5800 Highest 20500 22000 21000 18000 18000 17500 14500 15000 18000 14000 17000 17000 20500 22000 21000 Mean 9182 10212 10167 11318 9541 9462 9000 9253 9326 9000 9484 10029 9322 9804 9839 Median 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 No liverpool 99/00Region 00/01Region 01/02Region Lowest 6000 6000 5800 Highest 2050 2200 21000 0 0 Mean (mls) 9078 9908 9767 Median (mls) 8000 9750 9000 Table 14: Prescribed Dialysate Volumes (mls) of patients without Residual Renal Function 99/00Liverpool 00/01Liverpool 01/02Liverpool 00/01Hope 01/02Hope 99/00Regional 00/01Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 01/02Regional 99/00Hope Lowest 3000 3000 3000 4500 6000 6000 6000 5000 4500 4500 4500 4500 3000 3000 3000 Highest 12500 20500 16000 17000 17500 14700 12000 14000 14500 12500 15000 15000 17000 20500 16000 Mean 8271 8267 9130 8711 8654 8203 8144 8365 8371 7600 7897 8222 8194 8539 8673 Median 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 8000 99/00Region 00/01Region 01/02Region No liverpool Lowest 3000 3000 3000 Highest 1250 2050 16000 0 0 Mean (mls) 7955 8220 8334 Median (mls) 8000 8000 8000 Table 15: Prescribed Dialysate Volumes (mls) of patients with Residual Renal Function ____________________________________________________________ November 2005 Page 11
  13. 13. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ 6. KT/V urea -- Time trends • Regionally, there was a small increase in the median Total Kt/V over the 3 year audit period, with similar increases in all 4 units (Table 16). SRH RLH MRI RPH Region Region No Liverpool 1999/2000 2.18 1.83 1.88 1.92 2.00 2.02 2000/2001 2.26 1.95 1.96 2.09 2.10 2.12 2001/2002 2.23 1.95 2.01 2.16 2.08 2.09 Table 16: Total Kt/V • Regionally, there was little change in median dialysate Kt/V over the 3 year audit period. Small increases were seen at SRH and MRI, and small decreases at RLH and RPH (Table 17). Hope Liverpool MRI Preston Regional Region No Liverpool 1999/2000 1.72 1.48 1.51 1.68 1.63 1.66 2000/2001 1.81 1.56 1.61 1.71 1.68 1.72 2001/2002 1.78 1.44 1.61 1.65 1.65 1.66 Table 17: Dialysate Kt/V • Regionally, there was a small increase in median residual Kt/V over the 3-year audit period. An increase was seen at SRH, RLH and RPH and a decrease at MRI (Table 18). Hope Liverpool MRI Preston Regional Region No Liverpool 1999/2000 0.30 0.13 0.22 0.21 0.24 0.26 2000/2001 0.40 0.07 0.12 0.34 0.28 0.32 2001/2002 0.38 0.17 0.16 0.48 0.30 0.31 Table 18: Residual Kt/V • Regionally, over the 3 year audit period, there has been a small increase in the percentage of the patients with no residual renal function obtaining the RA recommendation for Total Kt/V > 1.7 &/or CCr > 50 (Table 19). ____________________________________________________________ November 2005 Page 12
  14. 14. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ • SRH started with and maintained the biggest proportion of patients with no residual renal function who obtained the RA recommendation. MRI and RPH increased the proportion of patients in this group over the audit period. RLH remained the same. SRH RLH MRI RPH Region Region No Liverpool 1999/2000 91 64 63 73 75 76 2000/2001 94 50 45 84 70 85 2001/2002 90 62 69 82 77 78 Table 19: Percentage of patients with no Residual Renal Function achieving Total Kt/V > 1.7 &/or Total CCr > 50 7 A comparative analysis of patient characteristics in the two groups who are achieving or not achieving the Renal Association standards for PD adequacy 7.1 Body Weight • Regionally, throughout the 3 year audit period, patients achieving the Renal Association recommendation for Kt/V and CCr have a lower mean weight than patients not achieving the recommendation ( below). • Patients at MRI, RPH and SRH achieving the Renal Association recommendation for Kt/V and CCr have a lower mean weight than patients not achieving the recommendation. This was only true at RLH in 2001/2002 (table 20,21). SRH RLH MRI RPH Region Region No liverpool 1999/2000 66.4 74.5 68.4 66 67 66.8 2000/2001 66 75.2 69.7 67.8 72.3 67.85 2001/2002 66.6 68.6 70 69.5 68.2 68.5 Table 20: Median weight (Kg) of Patients Achieving Renal Association Recommendation for Total Kt/V and/or Total CCr SRH RLH MRI RPH Region Region no Liverpool ____________________________________________________________ November 2005 Page 13
  15. 15. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ 1999/2000 75.8 72 73.4 76.5 75 75.4 2000/2001 72.6 73.9 74.2 70 73 72.8 2001/2002 82.5 72.1 76.7 76.3 76.65 77 Table 21: Median weight (Kg) of patients Not Achieving Renal Association Recommendation for Total Kt/V and/or Total CCr 7.2 Urine Output • Regionally, throughout the 3 year audit period, patients achieving the Renal Association Recommendation for Kt/V and CCr had higher mean urine output levels than patients not achieving the Renal Association Recommendation for Kt/V and CCr. This result was seen at every unit (Table 22,23). • Regionally, the mean urine output of those patients achieving the Renal Association Recommendation for Kt/V and CCr increased over the 3 years. Conversely, the mean urine output of patients not achieving the Renal Association Recommendation for Kt/V and CCr decreased over the 3 years. The results at the individual units were variable. 99/00Liverpool 00/01Liverpool 01/02Liverpool 99/00Regional 00/01Regional 01/02Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 00/01Hope 01/02Hope 99/00Hope Lowest 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Highest 1990 2570 2270 1960 2440 2370 3080 2630 2940 2550 2750 2900 3080 2750 2940 Mean 523 552 377 809 751 910 748 637 702 491 615 802 600 610 693 Median 345 430 160 805 690 950 560 470 625 325 500 625 460 470 520 No liverpool 99/00Region 00/01Region 01/02Region Lowest 0 0 0 Highest 3080 2750 2940 Mean (mls) 574 591 672 Median (mls) 440 455 500 Table 22: Urine output (mls) in Patients Achieving the RA Recommendation for Total Kt/V and/or Total CCr ____________________________________________________________ November 2005 Page 14
  16. 16. PD Adequacy Preliminary Report 1999 – 2002 _______________________________________________________________ 99/00Liverpool 01/02Liverpool 00/01Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 00/01Hope 00/01Liverpool 99/00Regional 01/02Regional 01/02Hope 99/00Hope Lowest 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Highest 820 320 610 570 360 420 750 870 1020 0 400 0 820 870 1020 Mean 187 107 120 243 91 775 168 204 141 0 96 0 170 133 109 Median 40 0 0 240 0 800 25 50 0 0 0 0 20 0 0 No liverpool 99/00Region 00/01Region 01/02Region Lowest 0 0 0 Highest 820 870 1020 Mean (mls) 127 164 111 Median (mls) 0 0 0 Table 23: Urine output (mls) in Patients not Achieving RA Recommendation for Total Kt/V and/or Total CCr 7.3 Peritoneal Dialysis Ultrafiltration • Regionally, throughout the 3-year audit period, the mean PD ultrafiltration was higher in patients achieving the RA recommendation for Total Kt/V and Total CCr than in patients not achieving the recommendation. Results from individual units were variable (Tables 24,25) • Regionally, over the 3-year audit period, there was little change in the mean PD ultrafiltration of patients achieving the recommendation but in those not achieving the recommendation it increased then decreased. Results from individual units were variable. 99/00Liverpool 00/01Liverpool 01/02Liverpool 00/01Hope 01/02Hope 99/00Regional 00/01Regional 01/02Regional 99/00Preston 00/01Preston 01/02Preston 99/00MRI 00/01MRI 01/02MRI 99/00Hope Lowest -700 -800 -70 -800 -700 -400 -1800 -920 -1250 -1200 -1560 -1920 -1800 -1560 -1920 Highest 3600 3900 3500 2400 3600 2500 2650 3850 3850 3200 3260 3550 3600 3900 3850 Mean 1457 1476 1217 773 956 1016 775 1153 1032 1049 969 1018 1126 1210 1117 Median 1300 1500 1150 700 1000 1000 800 1025 1100 1100 860 1025 1080 1150 1200 ____________________________________________________________ November 2005 Page 15

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