Peritoneal transport characteristics, comorbid diseases and survival in CAPD patients

* Objective: To evaluate the influence of initial peritoneal transport rate , serum albumin concentration, and comorbid diseases on continuous ambulato ry peritoneal dialysis (CAPD) patient survival. * Design: A prospective single-center study with a longterm follow-up. * Patients: A total of 213 consecutive CAPD patients, who underwent a perit oneal equilibration test (PEI) at a mean of 7 days (range 3 - 30 days) afte r beginning CAPD, were included in this study. One hundred twenty patients were male, 116 patients had comorbid diseases, and mean age was 49.5 years (range 18 - 76 years). * Methods: A modified PET was performed using 4.25% glucose dialysis soluti on. Based on the dialysate-to-plasma creatinine concentration ratio at 4 ho urs' dwell (D-4/P-4, Cr, 0.62 +/- 0.14), patients were divided into high (H ), high-average (HA), low-average (LA), or low (L) transporters. * Results: Of 213 patients, 16.9% were classified as H transporters, 30.5% as HA, 36.6% as LA, and 16.0% as L transporters. The H transporter group ha d a higher proportion of men, higher proportion of patients with comorbid d iseases, lower initial serum albumin concentration, lower D-4/D-0 glucose, and lower drained volume. The initial D-4/P-4 Cr correlated with initial se rum albumin (r = -0.35, p < 0.001). The patients with comorbid diseases had lower initial serum albumin and higher initial D-4/P-4, Cr. On Kaplan-Meie r analysis, 2-year patient survival of group H was significantly lower comp ared to the other groups combined (57.1% vs 79.5%, p = 0.009). On Cox propo rtional hazards analysis, age, comorbid diseases, initial serum albumin con centration, and initial D-4/P-4 Cr were found to be independent risk factor s for mortality. However, in the patients without comorbid diseases, patien t survival was not different between group H and the other transport groups combined (p > 0.05), and only age was found to be an independent risk fact or for mortality. * Conclusion: These data suggest that a high peritoneal transport rate at i nitial PET is associated with high mortality, and that this is in part due to an increased prevalence of comorbid disease in H transporters. These H t ransporters with comorbid diseases represent a subset of patients with an e specially poor prognosis. In patients without comorbid diseases, high trans port status or low serum albumin concentration was not an independent risk factor for mortality.