Adequacy of Dialysis in Anuric CAPD Patiens

Song, Ho Cheol; Kim, Young Ok; Kim, Byung Soo; Shin, Mi Jung; Kim, Young Soo; Shin, Seok Joon; Jin, Dong Chan; Kim, Yong Soo; Choi, Euy Jin; Chang, Yoon Sik

Abstract

BACKGROUND
Failure to achieve target values for both urea (Kt/V) and creatinine clearance has been associated with increased morbidity and mortality in CAPD patients. Current standard of adequacy CAPD is to provide a weekly normalized urea clearance of 2.0 or more and a creatinine clearance of 60 liter/ 1.73 m2 or more. Conventional CAPD in patients without residual renal function is associated with worse clinical outcomes. This study was designed to study the effect of increasing daily exchange frequency on dialysis adequacy in anuric CAPD patients. METHODS: The 27 anuric CAPD patients (patients on 4x2 L daily exchanges for 7 days) were selected and then they received standard dose dialysis (4x2 L daily exchanges for 7 days) followed by high dose dialysis (5x2 L daily exchanges). Weekly Kt/Vurea and weekly Ccr were measured at the end of standard and high dose dialysis. Adequate dialysis was defined as satisfying both weekly Kt/Vurea >2.0, weekly Ccr >60 L/1.73 m2 according to DOQI guideline. RESULTS: Selected patients were 12 men and 15 women, mean age was 49+/-2 years, mean weight was 59.2+/-0.1 kg , mean peritoneal dialysis duration was 51+/-5 months. Weekly Kt/V was 1.7+/-.3 in standard dose dialysis patients and 2.1+/-.4 in high dose dialysis patients, mean Ccr was 48.8+/-.2 L/ week/1.73 m2 in standard dose dialysis patients and 63.1+/-2.1 L/week/1.73 m2 in high dose dialysis patients. This difference is statistically significant (p< 0.05). Among 27 patients, only 2 standard dose dialysis patients were on adequate dialysis but in high dose dialysis group, 14 patients were on adequate dialysis according to DOQI guideline. In high dose dialysis, 14 on adequate dialysis and 13 inadequate dialysis were divided and their clinical factors were analyzed. Only volume of urea distribution (30.9+/-.9 L vs 37.7+/-.6 L) was significantly different (p<0.05). CONCIUSION: This study revealed most standard dose of anuric CAPD patients, who receiving daily 8 L dialysis did not dialyzed adequately by DOQI guideline. Increasing the number of exchanges effectively increased Kt/Vurea and weekly creatinine clearance in anuric CAPD patients.