Impact of dialysis adequacy on the mortality and morbidity of anuric Chinese patients receiving continuous ambulatory peritoneal dialysis

Dialysis adequacy has a major impact on the outcome of continuous ambulator y peritoneal dialysis (CAPD) patients. However, most studies on peritoneal dialysis adequacy have focused on patients with significant residual renal function. The present study examined the effect of dialysis adequacy on anu ric CAPD patients. A single-center prospective observational study on 140 a nuric CAPD patients was performed. These patients were followed for 22.0 +/ - 11.9 mo. Dialysis adequacy and nutritional indices, including Kt/V, creat inine clearance (CCr), protein equivalent nitrogen appearance, percentage o f lean body mass, and serum albumin level were monitored. Clinical outcomes included actuarial patient survival, technique survival, and duration of h ospitalization. In the study population, 64 were male, 36 (25.7%) were diab etic, and 59 (42.1%) were treated with 6 L exchanges per day. The body weig ht was 59.2 +/- 10.2 kg. Average Kt/V was 1.72 +/- 0.31, and CCr was 43.7 /- 11.5 L/wk per 1.73m(2). Two-yr patient survival was 68.8%, and technique survival was 61.4%. Multivariate analysis showed that DM, duration of dial ysis before enrollment, serum albumin, and index of dialysis adequacy (Kt/V or CCr) were independent factors of both patient survival and technique su rvival. It was estimated that for two patients who differed only in weekly Kt/V, a 0.1 higher value was associated with a 6% decrease in the RR of dea th (P < 0.05; 95% confidence interval, 0.92 to 0.99). Serum albumin and CCr were the only independent factors that predicted hospitalization. It was f ound that even when there is no residual renal function, higher dialysis do sage is associated with better actuarial patient survival, better technique survival, and shorter hospitalization. Dialysis adequacy has a significant impact on the clinical outcome of CAPD patients, and the beneficial effect is preserved in anuric patients as well as in an ethnic group that has a l ow overall mortality.