Percentage of Korean CAPD patients meeting DOQI guidelines - Analyzed using the computerized urea kinetic modeling -

Kim, Yong Lim; Kim, Jun Chul; Kim, Chan Duck; Kim, Jun Hong; Cho, Dong Kyu

Abstract

The DOQI guidelines recommend that the delivered PD dose should be a total weekly Kt/Vurea and Ccr values of at least 2.0 and 60 L/week/1.73 m2 for CAPD patients. To achieve these recommended guidelines, the standard regime of four 2-L daily exchanges may not be sufficient even for Oriental patients whose body size are relatively smaller than those of Westerners. However, the option of a two-and-a-half liter bag (2.5L) and a simple automated overnight exchange device for a fifth exchange are not available in some countries. In order to evaluate the percentage of CAPD patients who receive dialysis meeting DOQI guidelines in different dialysis prescriptions, 110 Korean patients, treated for over a 3 month on CAPD, with a mean age of 46.912.6 years and dialysis duration of 37.6+/-28.1 months (range 3-116), were studied.
METHODS
Baseline urea kinetic data from a 24-hour dialysate collection was obtained and analyzed using the computerized urea kinetic model of peritoneal urea transport (PACK-PD, vers 1.01, Fresenius). The potential Kt/Vurea and Ccr values using four 2L and 2.5L daily exchanges were calculated with the PC program.
RESULTS
The mean weekly Kt/Vurea and Ccr values were 2.01+/-0.67 and 66.4+/-29.6 L/week/1.73 m2 respectively, with a median body surface area (BSA) of 1.61 m2 (75th percentile 1.73 m2). The mean 24 hour dialysate-to-plasma creatinine ratio was 0.75+/-0.16. Fourty-five of the 110 patients (41%) had no residual renal function. Upon logistic regression analysis, Kt/Vurea was independent factor affecting serum albumin and NPCR. 1) In forty-eight (44%) of the 110 patients, both Kt/Vurea and Ccr values with four 2-L daily exchanges were adequate. In twenty-two (20%), one of Kt/Vurea and Ccr values with four 2-L daily exchanges was inadequate. In fourty (36%), both Kt/Vurea and Ccr values with four 2-L daily exchanges were inadequate. 2) In eighty-four (77%) of the 110 patients, both Kt/Vurea and Ccr values with four 2.5-L daily exchanges were adequate. In nineteen (17%), one of Kt/Vurea and Ccr values with four 2.5-L daily exchanges was inadequate. In seven (6%), both Kt/Vurea and Ccr values with four 2.5-L daily exchanges were inadequate. 3) In three (7%) of the fourty-five anuric patients, both Kt/Vurea and Ccr values with four 2-L daily exchanges were adequate. In eleven (24%), one of Kt/Vurea and Ccr values with four 2-L daily exchanges was inadequate. In thirty-one (69%), both Kt/Vurea and Ccr values with four 2-L daily exchanges were inadequate. 4) In twenty-seven (60%) of the fourty-five anuric patients, both Kt/Vurea and Ccr values with four 2.5-L daily exchanges were adequate. In thirteen (29%), one of Kt/Vurea and Ccr values with four 2.5-L daily exchanges was inadequate. In five (11%), both Kt/Vurea and Ccr values with four 2.5-L daily exchanges were inadequate. CONCLUSION: The anuric Korean patients may need four 2.5L daily exchanges for acceptable adequacy target. Special attention must be given to those patients with no residual renal function.