Impact of peritoneal membrane transport on technique failure and patient survival in a population on automated peritoneal dialysis

The peritoneal equilibration test (PET) is well established as a tool for c lassifying patients as low (L), low average (LA), high average (HA), or hig h (H) peritoneal transporters. We performed this retrospective 6 year cohor t survey to evaluate the impact of different types of PET results on techni que survival and patient survival on automated peritoneal dialysis (APD) th erapy. From March 1992 to May 1998, 50 patients (20 men, 30 women) receivin g APD were enrolled, The mean follow-up period was 25.2 +/- 9.2 months. Bas ic data and PET results of each patient at the initiation of APD therapy we re retrospectively obtained for analysis, Adequacy of dialysis was estimate d by measurement of total weekly urea clearance (Kt) normalized to total bo dy wafer (V) and total weekly creatinine clearance (Ccr) per 1.73 m(2) body surface area, The clinical outcomes evaluated were technique survival and patient survival. For statistical analyses we used the Kruskal-Wallis test, Friedman test Kaplan-Meier life table analysis, and Cox's proportional haz ards regression model. There were no differences in age, gender, prevalence of diabetes mellitus (DM), duration of APD, or the initial value of serum albumin between the four subgroups (H, HA, LA, and L). There were 11 (22%) deaths and 8 (16%) technique failures. The 2 year patient survival probabil ity was significantly higher (100%) in the L subgroup than in the LA (62.6% ), HA (48.4%), or H (46.2%) subgroups. Patients with DM had a lower patient survival rate than patients without DM; however, there was no statistical significance in technique survival rate between them. Diabetes mellitus (RR = 2.898) and the final albumin value (RR = 0.2099 per increase of 1 gm/dl) had a significant influence on patient survival. By stepwise regression an alysis elf final serum albumin levels, we found that patients with lower se rum albumin values (less than or equal to 3.0 gm/dl vs, >3.0 gm/dl) had a s ignificantly lower probability of patient survival (p = 0.0156). We conclus ively demonstrate four important findings in this work: 1) patients with H peritoneal transport had a lower probability of patient survival, but not a decreased rate of technique survival; 2) patients with L peritoneal transp ort can tolerate APD well; 3) there was no significant difference in techni que survival rate between the different PET subgroups; and 4) DEA and a low er serum albumin, implicating malnutrition, may contribute to the lower pro bability of patient survival among H peritoneal transporters.