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Dialysis adequacy of Asian patients receiving small volume continuous ambulatory peritoneal dialysis
1Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, China.
Insights
Lower volume peritoneal dialysis may be adequate for Asian patients. Studies show similar health outcomes and survival rates despite lower Kt/V levels, suggesting cost-effective dialysis options.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Public Health
Background:
- Continuous Ambulatory Peritoneal Dialysis (CAPD) is a common renal replacement therapy.
- Standard CAPD prescriptions vary globally, influenced by factors like cost and patient population.
- The adequacy of dialysis, often measured by Kt/V, is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the adequacy and outcomes of a standard 3x2 liter daily exchange CAPD regimen in Hong Kong.
- To compare patient characteristics and clinical outcomes between CAPD patients with Kt/V < 1.7 and Kt/V >= 1.7.
- To assess the long-term survival and rehabilitation status of CAPD patients on a potentially suboptimal dialysis prescription.
Main Methods:
- Cross-sectional study of 117 CAPD patients.
- Categorization of patients based on daily exchange volume (3x2L vs. 4x2L) and Kt/V levels (<1.7 vs. >=1.7).
- Analysis of demographic data, biochemical markers, clinical outcomes (peritonitis, hypertension), residual renal function, and survival rates.
Main Results:
- 78% of patients used the 3x2L exchange regimen; 15% were diabetic.
- No significant differences in age, CAPD duration, BUN, creatinine, albumin, peritonitis, or hypertension between Kt/V groups.
- Patients with Kt/V >= 1.7 had higher hemoglobin, nPCR, and residual renal function, and more received 4 daily exchanges.
- 5-year survival was 79% despite lower average Kt/V; higher protein catabolic rate noted in Asian patients.
Conclusions:
- A 3x2L daily exchange CAPD regimen may be acceptable for Asian patients, considering body size and financial constraints.
- Lower Kt/V levels might be tolerated in this population without compromising key clinical outcomes.
- Dietary differences may contribute to higher protein catabolic rates in Asian CAPD patients.
Abstract:
The usage of three x 2 liter daily exchanges is adopted as the standard CAPD regime in Hong Kong over the last 10 years due to budgetary constraint. This dialysis prescription is considered suboptimal in Western standard. However, the necessity of maintaining Kt/V > 1.7 for CAPD dialysis adequacy is not unanimously agreed. We performed a cross-sectional study of 117 patients on CAPD. Seventy-eight percent of our patients had 3 x 2 liter daily exchange while the rest had 4 daily exchanges. Fifteen percent of patients were diabetic. Patients with Kt/V < 1.7 were similar to those with Kt/V > 1.7 in age, duration of CAPD, BUN, plasma creatinine, albumin, peritonitis rate, and incidence of hypertension. Patients with Kt/V > or = 1.7 had higher hemoglobin, higher nPCR, more residual renal function; and more of them received 4 daily exchanges. Their peritoneal permeability did not differ. Their employment and rehabilitation status was also similar. Our 5-year survival was 79% despite a lower Kt/V. Notably, the protein catabolic rate of our patients was higher than that in Western patients. This is likely due to dietary difference. Our study suggests small-volume dialysis may be acceptable in Asian population with smaller body size given the financial constraint.