Are three exchanges suitable for Asian patients on peritoneal dialysis?

Area of Science:

• Nephrology
• Public Health

Background:

• Continuous ambulatory peritoneal dialysis (CAPD) use is increasing in Asian developing countries.
• Limited government and insurance coverage often restricts dialysis treatment expenses.
• Patients in countries like India, Bangladesh, Pakistan, and Nepal typically undergo three 2-L exchanges daily.

Purpose of the Study:

• To evaluate the effectiveness and outcomes of reduced-volume CAPD in Asian developing countries.
• To analyze factors influencing CAPD mortality rates in the Indian subcontinent.
• To determine if a lower dialysis dose is a viable compromise under financial constraints.

Main Methods:

• Retrospective analysis of CAPD patients in India and other Asian regions.
• Assessment of dialysis dose (Kt/V), survival rates, and normalized protein equivalent of nitrogen appearance.
• Evaluation of patient characteristics, including diet (vegetarianism) and comorbidities like diabetic nephropathy.

Main Results:

• Indian patients on three 2-L exchanges daily achieved a Kt/V of 1.67 with a 2-year survival rate of 60%.
• Vegetarian patients exhibited lower protein intake and serum albumin levels.
• Diabetic nephropathy prevalence contributes to differing CAPD mortality rates across Asian countries.

Conclusions:

• Small-volume dialysis (6 L daily) might be a feasible option for select Asian patients with financial limitations, smaller body size, and residual renal function.
• Individualizing dialysis dosage based on patient needs is crucial for optimal outcomes.
• Understanding regional variations in peritoneal membrane characteristics and disease prevalence is important for CAPD management in Asia.