Effect of fluid and sodium removal on mortality in peritoneal dialysis patients

Background. Adequacy of peritoneal dialysis (PD) traditionally is assessed using Kt/V-urea and total creatinine clearance (TCC). However. this approac h underestimates the importance of fluid and sodium removal. The aim of thi s study was to determine the effect of fluid and sodium removal on morbidit y and mortality in PD patients. Methods. One hundred twenty-five PD patients were monitored for three years from the beginning of the treatment. The effects of demographic features, comorbidity, peritonitis rate. blood pressure. medications, blood biochemis try, peritoneal membrane transport characteristics, residual renal function (RRF), Kt/V-urea, TCC, normalized protein nitrogen appearance (nPNA). and removal of sodium and fluid on mortality were evaluated. Total and cardiova scular hospitalization rates were also recorded. A Cox proportional hazards model was used to determine factors predicting mortality. Results. In the Cox model, comorbidity, total sodium and fluid removals, hy pertensive status, serum creatinine, and RRF ere independent factors affect ing survival. In contrast, Kt/V-urea or TCC did not affect the adjusted sur vivals. Total sodium and fluid removal and hypertensive status also signifi cantly influenced the hospitalization rate. Systolic and diastolic blood pr essures were negatively correlated with total fluid (P < 0.001) and sodium removal (P < 0.001). Conclusions. Together, these findings suggest that removal of sodium and fl uid is a predictor of mortality in PD patients. whereas Kt/V-urea, and TCC are not factors. Adequate fluid and sodium balance is crucial for the manag ement of patients on PD.