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ORIGINAL ARTICLES |
Australia and New Zealand Dialysis and Transplant Registry,1 Adelaide, Australia; Department of Renal Medicine,2 University Hospital of North Norway, Tromsö, Norway; Departments of Medicine and Public Health,3 University of Adelaide; Department of Renal Medicine,4 University of Queensland at Princess Alexandra Hospital, Brisbane, Australia
Correspondence to: D. Johnson, Department of Renal Medicine, Level 2, Ambulatory Renal and Transplant Services Building, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Brisbane, Qld 4102, Australia. david_johnson{at}health.qld.gov.au
Background: The contribution of peritoneal small solute
clearance per se to peritoneal dialysis (PD) patient outcomes remains
uncertain. The aim of the present study was to determine whether baseline
peritoneal small solute clearance predicted subsequent survival in Australian
and New Zealand PD patients. Methods: The study included all adult patients in
Australia and New Zealand that commenced PD between 1 April 2002 and 31
December 2005 and had a peritoneal Kt/V (pKt/V) measurement performed within 6
months of PD commencement. Time to death and death-censored technique failure
were examined by Kaplan–Meier analyses and both univariate and
multivariate Cox proportional hazards models. Results: pKt/V measurements were available in 2434
(63%) of the 3841 individuals that began PD treatment in Australia and New
Zealand during the study period. These patients were divided into 4 groups
according to their baseline pKt/V values: <1.45 (n = 599), 1.45
– 1.69 (n = 550), 1.70 – 2.00 (n = 607), and
>2.00 (n = 678). Compared with the reference group (pKt/V 1.70
– 2.00), patient mortality was significantly increased in individuals
with pKt/V <1.45 [adjusted hazard ratio (HR) 1.87, 95% confidence interval
(CI) 1.24 – 2.84; p = 0.003] and tended to be increased in
those with pKt/V 1.45 – 1.69 (adjusted HR 1.46, 95% CI 0.96 –
2.21; p = 0.074). Importantly, higher pKt/V values (>2.00) also
tended to be associated with higher mortality (adjusted HR 1.42, 95% CI 0.96
– 2.11; p = 0.079). The other independent predictors of death
were lower residual renal function (RRF), older age, peripheral vascular
disease, diabetes mellitus, late referral, higher peritoneal permeability, and
untreated hypertension. No interaction was observed between pKt/V, RRF, and
survival. Death-censored technique failure was demonstrated to be
significantly worse in the pKt/V 1.45 – 1.69 group (adjusted HR 1.36,
95% CI 1.03 – 1.79; p = 0.028), older individuals, and
individuals with Asian racial origin. Conclusions: Initial peritoneal Kt/V significantly and
independently influences patient survival in Australian and New Zealand PD
patients. Overall survival appears to be optimal in the pKt/V range 1.70
– 2.00, with poorer outcomes observed above and below these values. In
particular, survival is significantly worse when the achieved pKt/V is
<1.45. In addition, RRF is an important independent predictor of patient
survival in the Australian and New Zealand incident PD patient populations.
The results of this study should therefore draw attention to the possible
danger of not delivering adequate PD dose to patients with considerable
RRF.
KEY WORDS: Dialysis adequacy; dialysis dose; Kt/V; outcomes; patient survival; residual renal function.
Received 21 April 2008; accepted 19 November 2008.
This article has been cited by other articles:
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  E. Vonesh ON SMALL SOLUTE CLEARANCE AND PATIENT OUTCOMES: EVIDENTIAL PRACTICE OR OBSERVATIONAL TREPIDATION? Perit. Dial. Int., November 1, 2009; 29(6): 623 - 629. [Abstract] [Full Text] [PDF]
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