Importance of dialysis adequacy in mortality and morbidity of chinese CAPD patients.
BACKGROUND
In continuous ambulatory peritoneal dialysis (CAPD), the impact of dialysis adequacy on patient outcome is well established in Caucasian patients but is less clear in Asian patients. Recent evidence suggests that Asian dialysis patients enjoy better overall survival. We hypothesize that dialysis adequacy may be less important in determining outcome for this ethnic group.


METHODS
We performed a single-center prospective observational study. From September 1995, we enrolled 150 existing and 120 new CAPD patients. They were followed for up to three years. We monitored dialysis adequacy and nutritional indices, including Kt/V, weekly creatinine clearance (CCr), residual glomerular filtration rate (GFR), normalized protein catabolic rate (NPCR), percentage of lean body mass (%LBM), and plasma albumin level. Clinical outcomes included mortality, technique failure, and duration of hospitalization.


RESULTS
The duration of study follow-up was 22.1 +/- 12.3 months. In our study population, 136 were male. Seventy were diabetic (25.9%), and 212 were treated with 6 L exchanges per day (78.5%). The body weight was 59.3 +/- 9.4 kg. Baseline total Kt/V was 1.78 +/- 0.41, peritoneal Kt/V 1.48 +/- 0.36, and median residual GFR 0.98 mL/min (range 0 to 7.45). Two-year patient survival was 83.0%, and technique survival was 72.8%. Multivariate analysis showed that the duration of dialysis, diabetes, %LBM, index of dialysis adequacy (Kt/V or CCr), residual GFR, and requirement of a helper for CAPD exchanges were independent factors of patient survival; serum albumin, adequacy index (Kt/V or CCr), and requirement of a helper were independent factors of technique survival. Duration of dialysis, body weight, requirement of helper, cardiovascular disease, HBsAg carrier, serum albumin, and CCr had independent effects on hospitalization. The peritoneal component of Kt/V or CCr had no independent effect on any outcome parameter. When the prevalent and new CAPD cases were analyzed separately, Kt/V predicted survival only for new CAPD cases.


CONCLUSIONS
Our results show that dialysis adequacy has significant impact on outcome of Asian CAPD patients. Although we have excellent medium-term patient and technique survival, this favorable outcome should not prevent health care workers from providing adequate dialysis to Asian patients. The reason of discrepancy in outcome between Asian and Caucasian dialysis patients requires further study.
Szeto
C C
CC
Department of Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, China.
Wong
T Y
TY
Leung
C B
CB
Wang
A Y
AY
Law
M C
MC
Lui
S F
SF
Li
P K
PK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D003404:Creatinine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D015999:Multivariate Analysis; D009752:Nutritional Status; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000592:standards* / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis / Q000706:statistics & numerical data
D003404:Creatinine