Minimal and optimal peritoneal Kt/V targets: results of an anuric peritoneal dialysis patient's survival analysis.
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.
Lo
Wai-Kei
WK
Renal Unit, Department of Medicine, Tung Wah Hospital, The University of Hong Kong, Hong Kong. wkloc@hkucc.hku.hk
Lui
Sing-Leung
SL
Chan
Tak-Mao
TM
Li
Fu-Keung
FK
Lam
Man-Fai
MF
Tse
Kai-Chung
KC
Tang
Sydney Chi-Wai
SC
Choy
Cindy Bo-Ying
CB
Lai
Kar-Neng
KN
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