ADEQUACY OF DIALYSIS ON CAPD AT MEDIUM-LONG TERM - A STUDY ON UREA KINETICS IN PATIENTS OVER THERE YEARS ON TREATMENT

Urea kinetic modelling (UKM) is a useful tool/ to measure adequacy of dialysis in HD. for CAPD no similar prospective studies exist and prel iminary data have provoked controversy about the UKM usefulness for pr escription. The objective of the present paper is to study the role of UKM in defining adequacy of dialysis in a long-term selected CAPD pop ulation. The influence of peritoneal diffusion capacity on adequacy of dialysis is also considered. We have studied 56 patients treated for at least three years on CAPD. Every patient study period comprised of a year of observation. A careful record of all information about clini cal outcome and biochemical data was performed UKM included the determ ination of weekly urea KT/V and normalized PCR (NPCR). Results: Values lower than 1.2 are unequivocally associated to a higher morbidity, va lues lower than 1.7 are associated with uremic symptomatology and valu es lower than 1.8 with an increased mortality. KT/V over 1.7 entailed a lower hospitalization rate and a value over 2.1, the lowest morbidit y rate. For NPCR, values under 1 g/kg/day were associated with a highe r mortality and hospitalization rate. Peritoneal high diffusion capaci ty for small molecules is associated with poor nutritional outcome. Ou r data confirm that maintaining a serum albumin over 3.7-3.8 g/dl is a ssociated with lower morbidity and mortality as an independent value. Urea kinetic modelling is a useful tool to measure adequacy of dialysi s in CAPD patients treated over 3 years. It is necessary to reach valu es of weekly KT/V higher than 1.7 and NPCR higher than 1 g/kg/day in o rder to reduce the morbidity and mortality rates in these patients.