Trends in clinical indicators of care for adult peritoneal dialysis patients in the United States from 1995 to 1997

Background. This article describes the changes in four core indicator varia bles: dialysis adequacy, hematocrit, serum albumin, and blood pressure in p eritoneal dialysis CAPD and cycler patients over a three-year period. Methods. A national random sample of adult peritoneal dialysis patients in the United States was drawn each study period. Clinical data abstraction fo rms were completed by facility staff for patients selected for the sample, returned to the respective network, then forwarded to the Health Care Finan cing Administration for analysis. Results. The mean weekly Kt/V urea for CAPD patients increased from 1.91 in 1995 to 2.12 in 1997 (P < 0.001) and for cycler patients, from 2.12 in 199 6 to 2.24 in 1997 (P < 0.05). The mean weekly creatinine clearance for CAPD patients increased from 61.48 liter/week/1.73 m(2) in 1995 to 65.84 liter/ week/1.73 m(2) in 1997 (P < 0.05). For cycler patients, it increased from 6 3.37 liter/week/1.73 m(2) in 1996 to 67.45 liter/week/1.73 m(2) in 1997 (P < 0.05). Despite this increase in adequacy values, less than 40% of periton eal dialysis patients in 1997 had weekly Kt/V urea or creatinine clearance values that met subsequently published National Kidney Foundation's Dialysi s Outcomes Quality Initiative (DOQI) guidelines. These data suggest that th e dialysis prescription may not be adequately modified to compensate for in creased body weight and for decreased residual renal function as years on d ialysis increase. The average hematocrit value increased modestly in both C APD and cycler patients from 1995 to 1997, and the number of patients with a hematocrit of less than 25% decreased from 6% in 1995 to 1.4% in 1997 (P < 0.001). Both serum albumin values and systolic and diastolic blood pressu re values were essentially unchanged during the three-year period of observ ation. Conclusions. Despite improvements in dialysis adequacy and hematocrit value s, there remains much room for improvement in these core indicator values.