title: Minimal and optimal peritoneal Kt/V targets: results of an anuric peritoneal dialysis patient's survival analysis.
abstract: BACKGROUND
  Residual renal clearance has been shown to be much more predictive of survival than peritoneal clearance. There has been little data to support a target level of peritoneal clearance. A retrospective study was therefore conducted to see how the peritoneal Kt/V had affected the survival of anuric patients in our center.
  
  
  METHODS
  Over a period of 10 years, there were 150 peritoneal dialysis patients with documented anuria. Their survival was analyzed according to their baseline peritoneal Kt/V at the time of documentation of anuria and at the time of their latest altered peritoneal dialysis (PD) prescription (subsequent Kt/V).
  
  
  RESULTS
  There were 90 females and 42 diabetics. The mean age and duration of dialysis were 57.7 +/- 14.7 and 44.1 +/- 31.3 months, respectively. The 2-year and 5-year survival rates were 88.7% and 66.7%, respectively. We found that patients with baseline peritoneal Kt/V below 1.67 had poorer survival after the documentation of anuria than those above [relative risk (RR) 1.985, P= 0.01], although the baseline Kt/V was not an independent risk factors in the whole group of patients. However, such effect was mainly observed in female patients. The survival was identical between those with Kt/V above or below 1.80 (P= 0.98). Among female patients, the group with baseline Kt/V 1.67 to 1.86 had the best survival, followed by those greater than 1.86 and lowest in those below 1.67 (P= 0.0016). For patients with baseline Kt/V below 1.80, those with subsequent Kt/V above 1.76 had better survival than those below (P= 0.033).
  
  
  CONCLUSIONS
  Our data suggested that a negative effect of peritoneal Kt/V on survival is apparent at a level below 1.67 and there exists a limit of its effect at around 1.80. We suggested a minimal Kt/V target of 1.70 and an optimal target at 1.80 in anuric patients based on survival data. Prospective randomized study is required to confirm this finding.
authors.affiliation: Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong. wkloc@hkucc.hku.hk
authors.forename: Wai-Kei
authors.initials: WK
authors.lastname: Lo
authors.forename: Sing-Leung
authors.initials: SL
authors.lastname: Lui
authors.forename: Tak-Mao
authors.initials: TM
authors.lastname: Chan
authors.forename: Fu-Keung
authors.initials: FK
authors.lastname: Li
authors.forename: Man-Fai
authors.initials: MF
authors.lastname: Lam
authors.forename: Kai-Chung
authors.initials: KC
authors.lastname: Tse
authors.forename: Sydney Chi-Wai
authors.initials: SC
authors.lastname: Tang
authors.forename: Cindy Bo-Ying
authors.initials: CB
authors.lastname: Choy
authors.forename: Kar-Neng
authors.initials: KN
authors.lastname: Lai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001002:Anuria / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D001693:Biological Transport, Active; D005260:Female; D006723:Hong Kong / Q000453:epidemiology; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000401:mortality*; D010537:Peritoneum / Q000503:physiopathology*; D012189:Retrospective Studies; D016019:Survival Analysis