Patient-reported symptoms and adequacy of dialysis as measured by creatinine clearance

A patient-reported checklist was used to assess adequacy of dialysis as measured by 24-hour creatinine clearance in 40 patients on chronic peritoneal dialysis. The checklist consisted of 13 symptoms, each scored from 0-5 with 0 = absent and 5 = severe. The total possible score was 0-65. Patients completed the checklist at the time of 24-hour dialysate and urine collections (in those with residual function) for creatinine clearance (CrCl). Arbitrary grouping by total CrCl in liters/week/1.73 m2 placed patients in one of two groups: those with CrCl < or = 48 L/week (n = 12) and those with CrCl > 48 L/week (n = 28). Patient age, sex, diabetes mellitus, months on peritoneal dialysis, mode of peritoneal dialysis, and hematocrit were not different between the two patient groups. More patients with CrCl > 48 L/week had endogenous renal function (19/28 vs 2/12, p = 0.004). The median total scores for the two patient groups were not significantly different (17 in those with CrCl < or = 48 L/week vs 13.5 in those with CrCl > 48 L/week, p = 0.40). The correlation between total score and CrCl was negative in both patient groups and stronger in those with the lower CrCl (-0.55 vs -0.44). Nausea/vomiting, fatigue, and weakness were the best predictors of CrCl < or = 48 L/week (-0.53, -0.56, -0.49, respectively). The checklist can identify patients with low CrCl and may be useful for following patients over time and altering dialysis prescriptions.