Progressive Increases in Peritoneal Dialysis Prescription: Patient Acceptance and Complication Rates
Why this work is in the frame
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Bibliographic record
Abstract
Peritoneal dialysis adequacy has an impact on patient mortality. Both the CANUSA study and DOQI Guidelines outline targets for adequacy, and it has been suggested that quantitative adequacy determinations be made at regular intervals. Some groups believe these targets are not achievable because of lack of patient acceptance and high complication rate. We examined the outcome of peritoneal dialysis in a setting where prescription changes are made on clinical grounds, and determined the complication rates and patient acceptance of prescription changes. A total of 154 patients commencing peritoneal dialysis from January 1, 1994,-December 31, 1996, were studied to determine reasons for dialysis prescription changes, patient acceptance of, and complications related to these changes. Point prevalence data for dialysis prescription for our center and other Canadian centers were obtained from the Canadian Institute for Health Information. Co-morbidity - adjusted patient and technique survival for our center versus other centers in Canada was performed by Poisson regression analysis. Dialysis prescription changes were based on clinical assessment. A total of 102 patients started on either > 8 L of dialysate or had an increase in dialysis prescription during the study period. These patients were heavier, on peritoneal dialysis for longer, and fewer were transplanted compared with the patients on standard prescription (8 L or less). Only 4% of patients refused the change in dialysis prescription, and only 13 peritoneal leaks occurred, resulting in 3 transfers to hemodialysis. Our center prescribed a larger number of exchanges than other Canadian centers in 1995-1997. Adjusted mortality rate ratios for our center versus the other Canadian Centers (1990-1996) are equal. The 3 year technique survival for peritoneal dialysis patients from our center between 1990-1996 was 75% vs. 61% for other centers in Canada. At last follow-up, > 60% of patients had a Kt/V urea >2.1 and 45% had a creatinine clearance > 70 L/1.73 m2/week. This Regional Program has successfully prescribed high volume and frequency peritoneal dialysis on clinical grounds alone. This practice is associated with high patient acceptance, equivalent mortality, and higher technique survival compared with the rest of Canada.
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it