INCREASED PERITONEAL MEMBRANE-TRANSPORT IS ASSOCIATED WITH DECREASED PATIENT AND TECHNIQUE SURVIVAL FOR CONTINUOUS PERITONEAL-DIALYSIS PATIENTS

The objective of this study was to evaluate the association of periton eal membrane transport with technique and patient survival. In the Can ada-USA prospective cohort study of adequacy of continuous ambulatory peritoneal dialysis (CAPD), a peritoneal equilibrium test (PET) was pe rformed approximately 1 mo after initiation of dialysis; patients were defined as high (H), high average (HA), low average (LA), and low (L) transporters. The Cox proportional hazards method evaluated the assoc iation of technique and patient survival with independent variables (d emographic and clinical variables, nutrition, adequacy, and transport status). Among 606 patients evaluated by PET, there were 41 L, 192 LA, 280 HA, and 93 H. The 2-yr technique survival probabilities were 94, 76, 72, and 68% for L, LA, HA, and H, respectively (P = 0.04). The 2-y r patient survival probabilities were 91, 80, 72, and 71% for L, LA, H A, and H, respectively (P = 0.11). The 2-yr probabilities of both pati ent and technique survival were 86, 61, 52, and 48% for L, LA, HA, and H, respectively (P = 0.006). The relative risk of either technique fa ilure or death, compared to L, was 2.54 for LA, 3.39 for HA, and 4.00 for H. The mean drain volumes (liters) in the PET were 2.53, 2.45, 2.3 3, and 2.16 for L, LA, HA, and H, respectively (P < 0.001). After 1 mo CAPD treatment, the mean 24-h drain volumes (Liters) were 9.38, 8.93, 8.59, and 8.22 for L, LA, HA, and H, respectively (P < 0.001); the me an 24-h peritoneal albumin losses (g) were 3.1, 3.9, 4.3, and 5.6 for L, LA, HA, and K, respectively (P ( 0.001). The mean serum albumin val ues (g/L) were 37.8, 36.2, 33.8, and 32.8 for L, LA, HPI, and H, respe ctively (P < 0.001). Among CAPD patients, higher peritoneal transport is associated with increased risk of either technique failure or death . The decreased drain volume, increased albumin loss, and decreased se rum albumin concentration suggest volume overload and malnutrition as mechanisms. Use of nocturnal cycling peritoneal dialysis should be con sidered in H and HA transporters.