Dialysis Adequacy of Asian Patients Receiving Small Volume Continuous Ambulatory Peritoneal Dialysis

Abstract

The usage of three x 2 liter daily exchanges is adopted as the standard CAPD regime in Hong Kong over the last 10 years due to budgetary constraint. This dialysis prescription is considered suboptimal in Western standard. However, the necessity of maintaining Kt/V > 1.7 for CAPD dialysis adequacy is not unanimously agreed. We performed a cross-sectional study of 117 patients on CAPD. Seventy-eight percent of our patients had 3 x 2 liter daily exchange while the rest had 4 daily exchanges. Fifteen percent of patients were diabetic. Patients with Kt/V < 1.7 were similar to those with Kt/V > 1.7 in age, duration of CAPD, BUN, plasma creatinine, albumin, peritonitis rate, and incidence of hypertension. Patients with Kt/V > or = 1.7 had higher hemoglobin, higher nPCR, more residual renal function; and more of them received 4 daily exchanges. Their peritoneal permeability did not differ. Their employment and rehabilitation status was also similar. Our 5-year survival was 79% despite a lower Kt/V. Notably, the protein catabolic rate of our patients was higher than that in Western patients. This is likely due to dietary difference. Our study suggests small-volume dialysis may be acceptable in Asian population with smaller body size given the financial constraint.

Survival of Functionally Anuric Patients on Automated Peritoneal Dialysis

“…Although it seems that the dropout rate in this study was high, the 2-yr technique survival of 62% is similar to that of other multicenter studies (12,25). The main cause of transfer to hemodialysis was peritonitis (12% of all patients, 43% of transfers).…”

“…The results from EAPOS differ from those of the only other prospective study of anuric patients on PD (12), in which outcome was determined by small solute clearance. Mean Ccrea in that study was only 43.7 L/wk per 1.73 m 2 .…”

Predictors of Residual Renal Function Decline in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis

“…The rate of residual GFR decline was computed by the least squares linear regression formula. Anuria was defined as absence of appreciable urine output as in our previous study (23).…”

Clinical Outcomes of Peritoneal Dialysis Patients Transferred from Hemodialysis: A Matched Case–Control Study

“…If a patient died within 60 days after transfer to HD, the death was attributed to PD. Technique survival was defined as the percentage of patients who remained alive and on PD therapy (13). For both of the foregoing outcomes, survival was calculated from the date of commencement of PD therapy to the date of death, transfer to HD, transplantation, recovered renal function, loss to follow-up, or 30 June 2009.…”