Background:
There has been a lack of randomized control study on the effect of kt/v on patient outcome. this interventional study was designed to examine the effect of kt/v on continuous ambulatory peritoneal dialysis (capd) patients' clinical outcome and nutritional status in a randomized prospective manner.
Method:
A total of 320 new capd patients with baseline renal kt/v <1.0 were recruited from six centers in hong kong and were randomized into three kt/v targets: group a, 1.5 to 1.7; group b, 1.7 to 2.0; and group c,>2.0. kt/v and nutritional status were assessed every 6 months and dialysis prescription adjusted accordingly. nutritional assessment included serum albumin and composite nutritional index (cni). patients were allowed to withdraw at the discretion of their physicians or themselves.
Results:
Total kt/v were significantly different between groups (p = 0.000) and the difference was contributed by peritoneal kt/v only. the overall 2-year patient survival was 84.9%. there was no statistical difference in patient survival among the three groups (2-year survival in group a, 87.3%; group b, 86.1%; and group c, 81.5%). however, there were more patients withdrawn by physicians in group a (group a, 16; group b, 7; and group c, 6; p = 0.023). total kt/v or kt did not significantly affect survival after adjustment to age and diabetes. there was no difference in serum albumin, cni scores, and hospitalization rate, but there were more patients in group a requiring erythropoietin (epo) treatment after 1 year.
Conclusion:
Patients with total kt/v maintained below 1.7 had significantly more clinical problems and severe anemia but there was no difference in outcome demonstrated for patients with kt/v maintained above 2.0 and between 1.7 and 2.0. we recommended that the minimal target of total kt/v should be above 1.7.