Relationship between adequacy of dialysis and nutritional status, and their impact on patient survival on CAPD in Hong Kong

Objective: Superior patient survival on continuous ambulatory peritoneal di alysis (CAPD) with 3 x 2-L exchanges has been reported from Hong Kong. This study examined the relationship between indices of dialysis adequacy and n utrition and patient survival on CAPD in Hong Kong. Design: A cross-sectional study on prevalent CAPD patients. Patients were a ssessed for indices of dialysis adequacy and nutritional status with a comp osite nutritional index (CNI). Patients were then followed for 24 months. S urvival data were analyzed according to adequacy indices and nutritional st atus. Setting: All prevalent CAPD patients in nine dialysis centers in Hong Kong as of 1 April 1996. Main Outcome Measure: Mortality. Results: 937 patients were assessed: 68.2% were using 3 x 2-L exchanges per day; mean age was 54.6 +/- 13 years. Mean total Kt/V was 1.83 +/-0.42 and total creatinine clearance was 55.6 +/- 19.5 Uweek/1.73 m(2). 19% of patien ts were moderately to severely malnourished according to the CNI. There was no significant correlation between indices of adequacy and serum albumin o r CNI. The 1- and 2-year patient survival from the time of assessment was 9 0.9% and 79.8%. There was a trend toward better survival in patients with K t/V greater than 2.0, but it was not statistically significant. Peritoneal Kt/V did not impact survival in anuric patients. Malnourished patients had poorer survival than patients who were better nourished (p=0.0259). After a djusting for age and diabetes, CNI was predictive of mortality but Kt/V and creatinine clearance were not. Conclusions:This study demonstrates the importance of nutritional status ov er adequacy indices in predicting patient survival. There was a lack of cor relation between nutritional status and conventional indices of dialysis ad equacy.