ADEQUACY OF DIALYSIS IN CAPD - LONG-TERM RESULTS .2. STUDY ON THE VALIDITY OF CREATININE KINETICS IN PATIENTS TREATED MORE THAN 3 YEARS

Urea kinetic modelling (UKM) is a useful tool to measure adequacy of d ialysis in HD. For CAPD no similar prospective studies exist and preli minary data have provoked controversy about the usefulness UKM for CAP D prescription. On the other hand, creatinine kinetics have been propo sed as an alternative to define adequacy of dialysis. The object of th e present paper is to study the role of creatinine kinetics in definin g adequacy of dialysis in a long-term selected CAPD population. We hav e studied 56 patients treated for al least three years on CAPD. A care ful record of all information about clinical outcome and biochemical d ata was performed. The study of creatinine kinetics included the effic acy number (EN) of creatinine (liters cleared per gram of creatinine p roduced in 24 hours) and the determination of total creatinine clearan ce corrected for body surface (liters/week/1,73 sqn). EN and KT of cre atinine showed a significant correlation (r: 0,77). During the study p eriod EN decreased from 9.03 +/- 2.4 to 6.08 +/- 0.97 l/g creatinine/d ay (p < 0.01) and KT from 65.9 +/- 14 to 51.2 +/- 4.2 l/week (p < 0.01 ). A group of 15 patients with values of EN-creatinine between 4 and 5 l/g creatinine/day showed an appropriate clinical outcome free of com plications. The survival analysis for different stratified values of E N and KT/1,73 m2 of creatinine did not show significant differences in terms of mortality. We have not found differences for morbidity and h ospitalization rate, independent of peritonitis, for the different tes ted values of EN and KT of creatinine. Our data do not confirm the val idity of creatinine kinetics for predicting clinical outcome in CAPD p atients treated over more than three years.