Body surface area, adequacy, and technique failure in chronic peritoneal dialysis

Large body surface area (BSA) could be a pitfall in long-term peritoneal dialysis. We analyzed the viability of the peritoneum in terms of adequacy and technique survival in patients of varying BSA. We grouped our PD patients into three categories (BSA < or = 1.59 m2, BSA 1.60 - 1.79 m2, and BSA > or = 1.80 m2) and used the Student t-test to compare the mean weekly Kt/V urea between the groups (significance set at p < 0.05). We also measured and used Kaplan-Meier analysis to compare technique survival overall and in anuric patients from the onset of PD to the endpoints of transfer to hemodialysis or death linked to dialysis technique (log-rank test, p < 0.05). Group A consisted of 24 patients [2 men, 22 women; age: 41.9 +/- 12 years; BSA: 1.49 +/- 0.07 m2; total treatment duration: 1703.4 patient-months (mean: 71 +/- 50.6 months); diabetic: 8.33%; anuric: 62%; weekly Kt/V urea: 2.36 +/- 0.45; technique survival: 100%, 89%, 89%, 53%, and 53% at 1, 3, 5, 8, and 15 years]. Group B consisted of 35 patients [12 men, 23 women; age: 57.19 +/- 18 years; BSA: 1.69 +/- 0.05 m2; total treatment duration: 1870 patient-months (mean: 53.4 +/- 462 months); diabetic: 17.14%; anuric: 37.14%; weekly Kt/V urea: 2.28 +/- 0.41; technique survival: 97%, 93%, 87%, 78%, and 19% at 1, 3, 5, 8, and 14 years]. Group C consisted of 34 patients [24 men, 10 women; age: 56.2 +/- 13 years; BSA: 1.90 +/- 0.09 m2; total treatment duration: 1557.5 patient-months (mean: 45.8 +/- 34.4 months); diabetic: 20.6%; anuric: 41%; weekly Kt/V urea: 1.98 +/- 0.38; technique survival: 97%, 79%, 67.6%, 56%, and 28% at 1, 3, 5, 8, and 12 years]. Using the log-rank test, comparisons of technique survival overall and in anuric patients showed for A vs. B, p = 0.49 and p = 0.58 respectively; for A vs. C, p = 0.45 and p = 0.06; for B vs. C, p = 0.56 and p = 0.10. No significant differences in weekly Kt/V urea were observed between the groups (all p > 0.05). Peritoneal dialysis is viable for patients with a high BSA. There is a tendency toward worse technique survival in anuric patients with a high BSA.