THE EFFICACY NUMBER AS A PREDICTOR OF MORBIDITY AND MORTALITY IN PERITONEAL-DIALYSIS PATIENTS

The efficacy number has been proposed as a predictor of clinical outco me in patients on chronic ambulatory peritoneal dialysis (CAPD). The u sefulness of this parameter in a large group of CAPD patients was anal yzed. Forty-five patients who have received chronic CAPD therapy for a t least 1 yr were included in the study. The efficacy number was compa red with outcome as defined by mortality and days of hospitalization. Other demographic and laboratory parameters, including gender; race; p resence of diabetes; serum albumin, serum creatinine, and BUN levels; and measures of peritoneal transport, including dialysate-to-plasma cr eatinine and dialysate-to-plasma urea ratios, were also assessed for t heir role in predicting outcome. Laboratory values were obtained at th e initiation of CAPD and at 12 months after the start of CAPD. By univ ariate analysis, a low 12-month serum albumin level was the best predi ctor of mortality (P < 0.005), followed by a high 12-month efficacy nu mber (P < 0.05). After adjusting for age and the presence of diabetes, these two variables remained the best predictors of mortality (P < 0. 08 and < 0.09, respectively). A low initial serum albumin level was al so a strong predictor of mortality (P < 0.09). By univariate analysis, the best predictor of hospitalization was a low serum albumin level o btained either initially or at 12 months (P < 0.005 for both time peri ods). After adjusting for age and the presence of diabetes, the 12-mon th serum albumin level remained a significant predictor of hospitaliza tion (P < 0.03), whereas efficacy number was not a strong predictor (P = 0.27). In addition, there were statistically significant positive c orrelations between days of hospitalization and both efficacy number a nd serum glucose and significant negative correlations between days of hospitalization and both serum albumin and serum creatinine. In concl usion, a low initial or 12-month serum albumin level is a strong predi ctor of both mortality and hospitalizations. The results on efficacy n umber presented here are the opposite of those of others because it wa s observed in this study that a high 12-month efficacy number was almo st as strong a predictor of mortality as a low serum albumin level. Fu rther studies are required to determine the usefulness of the efficacy number in predicting outcome in CAPD patients.