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Open Access Highly Accessed Research article

Prognostic factors of all-cause mortalities in continuous ambulatory peritoneal dialysis: a cohort study

Phisitt Vejakama12, Ammarin Thakkinstian1*, Atiporn Ingsathit1, Prateep Dhanakijcharoen3 and John Attia4

Author Affiliations

1 Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand

2 Bundarik Hospital, Bundarik district, Ubon Ratchathani province, Thailand

3 National Health Security Office, Bangkok, Thailand

4 Centre for Clinical Epidemiology and Biostatistics, School of Medicine and Public Health, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia

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BMC Nephrology 2013, 14:28  doi:10.1186/1471-2369-14-28

Published: 31 January 2013

Abstract

Background

The role of small solute clearance on mortalities in patients with CAPD has been controversial. We therefore conducted a study with 3 years' follow up in adult patients who participated in the CAPD-first policy.

Methods

There were 11,523 patients with end-stage renal disease who participated in the CAPD-first policy between 2008 and 2011. Among them, 1,177 patients were included in the retrospective cohort study. A receiver operating characteristic curve was applied to calibrate the cutoffs of tKt/V, rKt/V and tCrcl. Kaplan-Meier and Cox-regression models with time varying covariates were applied to estimate overall death rate, probability of death and prognosis, respectively.

Results

The cutoffs of rKt/V and tKt/V were 0.25 and 1.75, respectively. The Cox regression suggested that the higher these clearance parameters, the lower the risks of death after adjusting for covariables. The risks of death for those above these cutoffs were 57% (HR = 0.43, 95% CI: 0.31, 0.60) and 29% (HR = 0.71, 95% CI: 0.52, 0.98) lower for rKt/V and tKt/V, respectively. Age, serum albumin, hemoglobin, systolic blood pressure, and ultra-filtration volume significantly affected the mortality outcome.

Conclusions

Our study suggested that the cutoffs of 0.25 and 1.75 for rKt/V and tKt/V might be associated with mortality in CAPD patients. A minimum tKt/V of 1.75 should be targeted, but increased dialysis dosage to achieve tKt/V > 2.19 adds no further benefit. Serum albumin, hemoglobin, SBP, and UF volume are also associated with mortality. However, our study may face with selection and other unobserved confounders, so further randomized controlled trials are required to confirm these cutoffs.

Keywords:
Adequacy indices; CAPD; Continuous ambulatory peritoneal dialysis; Mortality; Peritoneal small solute clearance; Prognostic factors