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Kidney Int. 2003 Aug;64(2):649-56.

Effect of Kt/V on survival and clinical outcome in CAPD patients in a randomized prospective study.

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1
Division of Nephrology, Department of Medicine, Tung Wah Hospital, and The University of Hong Kong, Hong Kong. wkloc@hkucc.hku.hk

Abstract

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 However, there were more patients withdrawn by physicians in group A (group A, 16; group B, 7; and group C, 6; P = 0.023).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.

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