Importance of dialysis adequacy in mortality and morbidity of Chinese CAPDpatients

Background. In continuous ambulatory peritoneal dialysis (CAPD), the impact of dialysis adequacy on patient outcome is well established in Caucasian p atients but is less clear in Asian patients. Recent evidence suggests that Asian dialysis patients enjoy better overall survival. We hypothesize that dialysis adequacy may be less important in determining outcome for this eth nic group. Methods. We performed a single-center prospective observational study. From September 1995, we enrolled 150 existing and 120 new CAPD patients. They w ere followed for up to three years. We monitored dialysis adequacy and nutr itional indices, including Kt/V, weekly creatinine clearance (C-Cr), residu al glomerular filtration rate (GFR), normalized protein catabolic rate (NPC R), percentage of lean body mass (%LBM), and plasma albumin level. Clinical outcomes included mortality, technique failure, and duration of hospitaliz ation. Results. The duration of study follow-up was 22.1 +/- 12.3 months. In our s tudy population, 136 were male. Seventy were diabetic (25.9%), and 212 were treated with 6 L exchanges per day (78.5%). The body weight was 59.3 +/- 9 .4 kg. Baseline total Kt/V was 1.78 +/- 0.41, peritoneal Kt/V 1.48 +/- 0.36 , and median residual GFR 0.98 mL/min (range 0 to 7.45). Two-year patient s urvival was 83.0%, and technique survival was 72.8%. Multivariate analysis showed that the duration of dialysis, diabetes, %LBM, index of dialysis ade quacy (Kt/V or C-Cr), residual GFR, and requirement of a helper for CAPD ex changes were independent factors of patient survival; serum albumin, adequa cy index (Kt/V or C-Cr), and requirement of a helper were independent facto rs of technique survival. Duration of dialysis, body weight, requirement of helper, cardiovascular disease, HBsAg carrier, serum albumin, and C-Cr had independent effects on hospitalization. The peritoneal component of Kt/V o r C-Cr had no independent effect on any outcome parameter. When the prevale nt and new CAPD cases were analyzed separately, Kt/V predicted survival onl y for new CAPD cases. Conclusions. Our results show that dialysis adequacy has significant impact on outcome of Asian CAPD patients. Although we have excellent medium-term patient and technique survival, this favorable outcome should not prevent h ealth care workers from providing adequate dialysis to Asian patients. The reason of discrepancy in outcome between Asian and Caucasian dialysis patie nts requires further study.