Survival of Capd Patients in a Center Using Three Two-Liter Exchanges as Standard Regime

Abstract

Our objectives were to study long-term patient survival and dialysis adequacy of continuous ambulatory peritoneal dialysis (CAPD) patients treated with a standard regime of three 2-L daily exchanges. It was a retrospective analysis of patient survival and cross-sectional analysis of adequacy of dialysis. The setting was a dialysis unit in a tertiary referral center of a teaching hospital. All patients (n = 507) accepted into the CAPD program from 1983 to June 1994, were analyzed for survival. Adequacy of dialysis was analyzed in all existing patients in 1993 to 1994. The overall patient survival was 93%, 71%, and 57% at one, three, and five years, respectively. The three-year survival rate was 40% for diabetics and 78% for nondiabetics. It was 86%, 85%, 64%, and 43% for patients aged <35, 35 -50, 50 -65, and over 65 years, respectively. The mean weekly KT/V of 201 existing CAPD patients was 1.76, and creatinine clearance was 57 Uweek/1.73 m2. KT/V by dialysis was only 1.57. The age and disease-adjusted survival in our center was comparable to centers that used standard four 2-L exchange regimes, despite a substantially lower mean KT/V and creatinine clearance (CrCI).

Effect of Kt/V on survival and clinical outcome in CAPD patients in a randomized prospective study

“…In Hong Kong, we have reported good CAPD survival on routine three 2 L daily exchange regime and a low mean total Kt/V of 1.76 [8]. Good survival rates had also been reported in American Asian patients and some other Asian countries like Korea and Japan with different dialysis prescriptions [9][10][11].…”

The Use of Incremental Peritoneal Dialysis in a Large Contemporary Peritoneal Dialysis Program

“… 17 , 27 Second, renal clearance is associated with superior outcomes in a way that equivalent amounts of peritoneal clearance are not. 15 , 28 It is a reasonable conclusion from this that if 2 patients have the same total clearance but one derives it from a mix of renal and peritoneal clearance while the other has it from peritoneal clearance alone, then the former scenario is associated with better survival. A patient receiving incremental PD is therefore unlikely to be disadvantaged relative to the same patient receiving a higher dose of peritoneal clearance.…”

“… 14 It is recognized that standard PD prescriptions may differ between countries. 15 These “Full-Dose PD” patients can be subdivided into those who achieve the Kt/V target with peritoneal Kt/V alone and those who achieve it through a combination of both peritoneal and residual renal clearance.…”

Why Is the Evidence Favoring Hemodialysis over Peritoneal Dialysis Misleading?

“…Survival in PD patients in Hong Kong, first reported in 1996, demonstrated a somewhat ''surprising'' good outcome, particularly with its standard 3 two-liter dialysis regime (4). Thereafter, more reports from other dialysis centers showed similar results.…”

“…In 1996, the Hospital Authority of Hong Kong established the Hong Kong Renal Registry which has made survival reports covering all public dialysis patients available in recent years (5). Table 1 shows a summary of the patient survival data from Hong Kong compared to that from other countries (2,4–9). PD patients in Hong Kong (and also from some other Asian countries) have generally better survival than those in the western world.…”