ASPD: A prospective study of adequacy in Asian patients on long term, small volume, continuous ambulatory peritoneal dialysis.
BACKGROUND
The impact of small solute clearance on patient survival in continuous ambulatory peritoneal dialysis (CAPD) is not yet solidified. Previously, we demonstrated that CAPD using small volume (6 L) daily exchanges provides adequate dialysis for most Asian patients.


METHODS
We conducted a prospective, long-term observational study to determine the optimal dialysis adequacy that may provide better patient survival for Asian patients who receive small-volume CAPD. We recruited 294 patients. The initial CAPD regime was 3 x 2-L exchanges daily. The same regime was maintained unless there was significant loss of ultrafiltration or fluid retention despite the use of hypertonic dialysate.


RESULTS
Median study period was 38.9 (range 5 - 76.5) months, with 81% and 27% of patients remaining in the study at 24 and 48 months respectively. The overall survival rates at 2 and 4 years were 94.0% and 74.8% respectively. Our long-term data revealed that survival rate was related to Kt/V values. Survival rates were significantly higher for patients with total Kt/V > 2.0 than for patients with Kt/V < 1.7 (p = 0.02). The former group had lower body mass index and higher residual renal function and peritoneal Kt/V than the Latter group. On analysis using Cox proportional hazards regression models, cardiovascular disease (CVD), lower urine volume, and higher body mass index were independent predictors of mortality. Patients with higher renal Kt/V had a significantly lower risk of mortality (RR = 0.018, p = 0.01) after adjusting for the effects of CVD and diabetes mellitus.


CONCLUSIONS
Our data recommend that 1.7 be the minimal target for total Kt/V in patients on long-term CAPD. Patients with high body mass index, low residual urine volume, and significant CVD need close monitoring.
Lam
Man Fai
MF
Renal Units, Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong.
Tang
Colin
C
Wong
Andrew K
AK
Tong
Kwok Lung
KL
Yu
Alex W
AW
Li
Chun Sang
CS
Cheung
King On
KO
Lai
Kar Neng
KN
D000328:Adult; D000368:Aged; D003404:Creatinine / Q000378:metabolism; D005260:Female; D005919:Glomerular Filtration Rate; D006723:Hong Kong; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000401:mortality / Q000706:statistics & numerical data*; D016019:Survival Analysis; D016896:Treatment Outcome
D003404:Creatinine