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Adequacy |
VAPHCS,1 Pittsburgh, Pennsylvania; DCI,2 Nashville, Tennessee; St Raphael,3 New Haven, Connecticut; Univ of Pittsburgh School of Med,4 Pittsburgh, Pennsylvania, USA.
Objective: In response to recent randomized controlled trials,
2006 Kidney Disease Outcomes Quality Initiative (K/DOQI) revised the
peritoneal dialysis (PD) adequacy guidelines to a minimum level total Kt/V of
1.7. Observational studies suggest that mortality may be higher in those with
Kt/V below 1.8. We evaluated the association of Kt/V with outcomes in anuric
PD patients. Methods: Adult anuric PD patients receiving dialysis
care in Dialysis Clinics, Inc. unit or the New Haven CAPD unit were selected
for study. The clearance for analysis was within 60 days of anuria. Kt/V was
classified as <1.7, 1.7–2.0, and >2.0. Mortality and time to first
hospitalization were analyzed using Cox proportional hazards.
Results: The study population was 1429 individuals, mean age 54, 62%
white, 30% black, 8% other, 50% women, 45% diabetes, median end-stage renal
disease (ESRD) time prior to anuria 21.3 months (range 0–27 years),
median follow-up time 10 months (range 0.03–90). In unadjusted analysis,
both Kt/V <1.7 and Kt/V 1.7–2.0 were associated with higher mortality
(Table 1). After adjustment, Kt/V <1.7 remained associated with increased
mortality although Kt/V 1.7–2.0 was no longer statistically significant.
Kt/V <1.7 was associated with time to first hospitalization, which
persisted after adjustment (Table).
Mortality HR (95% CI) Hospitalization HR (95% CI) Kt/V Unadjusted Adjusted
Unadjusted Adjusted* <1.7 1.5 (1.2,2.0) 1.4 (1.02, 1.8) 1.4 (1.2, 1.6) 1.3
(1.1, 1.6) p<0.001 p=0.03 p<0.001
p=0.002 1.7-2.0 1.3 (1.03, 1.6) 1.2 (0.96, 1.6) 1.05 (0.9, 1.2) 1.02
(0.9, 1.2) p=0.03 p=0.11 p=0.48 p=0.84
>2.0 1.0 1.0 1.0 1.0 *Adjusted for age, race, gender, albumin,
log(prior ESRD time), body mass index, diabetes. Conclusions: Lower
Kt/V, especially less than 1.7, is associated with adverse outcomes in anuric
peritoneal dialysis patients. Our results support the new K/DOQI
guidelines.
This article has been cited by other articles:
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  T.-C. Lee, J.-Y. Yang, H.-P. Wang, T.-J. Tsai, and Y. Yang Peritoneal thickening is not inevitable in long-term peritoneal dialysis and is associated with peritoneal transport characteristics: a two-centre sonographic study Nephrol. Dial. Transplant., March 1, 2008; 23(3): 1005 - 1010. [Abstract] [Full Text] [PDF]
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