High flux peritoneal membrane is a risk factor in survival of CAPD treatment

A high dropout rate is a major problem of continuous ambulatory peritoneal dialysis (CAPD) treatment. Serum albumin is both a significant parameter of dropout in CAPD and a predictor of peritoneal transport category based on the peritoneal equilibration test (PET). High flux peritoneal membrane (HFPM) may lose more protein in the dialysate. We examined the effect of HFPM on the survival of treatment of CAPD. The study was composed of 171 adult patients who had standard PET. The peritoneal transport category was based on their first PET after starting CAPD. The HFPM was defined as the dialysate-to-plasma creatinine concentration ratio (D/P) of more than one standard deviation of the mean (0.702 +/- 0.114; D/P > 0.816). Twenty-two patients had HFPM. The other 149 patients were categorized as the non-high flux group. The high flux group had a significantly lower serum albumin at PET (3.07 +/- 0.15 vs 3.68 +/- 0.05 g/dL, respectively p < 0.0001) and lower mean serum albumin during treatment than the non-high flux group (3.40 +/- 0.20 vs 3.70 +/- 0.04 g/dL, respectively, p = 0.020), and lower net drainage volume (p = 0.0007), but age, diabetes, total Kt/V, and total normalized weekly creatinine clearance were not different between groups. The risk of dropout was higher in the high flux group (p = 0.0127, Cox-Mantel log rank test), and the risk increased, especially after 1.5 years of treatment. Corrected for other risk factors, patients who had HFPM have two times the risk of dropout compared to the non-high flux groups (p = 0.0401, Cox proportional hazards model).