Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia.
Perit Dial Int. 2009 Nov-Dec;29(6):637-46.
The contribution of peritoneal small solute clearance per se to peritoneal dialysis (PD) patient outcomes remains uncertain. The aim of the present study was to determine whether baseline peritoneal small solute clearance predicted subsequent survival in Australian and New Zealand PD patients.
The study included all adult patients in Australia and New Zealand that commenced PD between 1 April 2002 and 31 December 2005 and had a peritoneal Kt/V (pKt/V) measurement performed within 6 months of PD commencement. Time to death and death-censored technique failure were examined by Kaplan-Meier analyses and both univariate and multivariate Cox proportional hazards models.
pKt/V measurements were available in 2434 (63%) of the 3841 individuals that began PD treatment in Australia and New Zealand during the study period. These patients were divided into 4 groups according to their baseline pKt/V values: <1.45 (n = 599), 1.45 - 1.69 (n = 550), 1.70 - 2.00 (n = 607), and >2.00 (n = 678). Compared with the reference group (pKt/V 1.70 - 2.00), patient mortality was significantly increased in individuals with pKt/V <1.45 [adjusted hazard ratio (HR) 1.87, 95% confidence interval (CI) 1.24 - 2.84; p = 0.003] and tended to be increased in those with pKt/V 1.45 - 1.69 (adjusted HR 1.46, 95% CI 0.96 - 2.21; p = 0.074). Importantly, higher pKt/V values (>2.00) also tended to be associated with higher mortality (adjusted HR 1.42, 95% CI 0.96 - 2.11; p = 0.079). The other independent predictors of death were lower residual renal function (RRF), older age, peripheral vascular disease, diabetes mellitus, late referral, higher peritoneal permeability, and untreated hypertension. No interaction was observed between pKt/V, RRF, and survival. Death-censored technique failure was demonstrated to be significantly worse in the pKt/V 1.45 - 1.69 group (adjusted HR 1.36, 95% CI 1.03 - 1.79; p = 0.028), older individuals, and individuals with Asian racial origin.
Initial peritoneal Kt/V significantly and independently influences patient survival in Australian and New Zealand PD patients. Overall survival appears to be optimal in the pKt/V range 1.70 - 2.00, with poorer outcomes observed above and below these values. In particular, survival is significantly worse when the achieved pKt/V is <1.45. In addition, RRF is an important independent predictor of patient survival in the Australian and New Zealand incident PD patient populations. The results of this study should therefore draw attention to the possible danger of not delivering adequate PD dose to patients with considerable RRF.
腹膜小分子清除本身对腹膜透析（PD）患者结局的贡献仍不确定。本研究旨在确定基线腹膜小分子清除率是否可预测澳大利亚和新西兰 PD 患者随后的生存情况。
本研究纳入了 2002 年 4 月 1 日至 2005 年 12 月 31 日期间在澳大利亚和新西兰开始 PD 治疗的所有成年患者，并且在 PD 开始后 6 个月内进行了腹膜 Kt/V（pKt/V）测量。采用 Kaplan-Meier 分析和单变量及多变量 Cox 比例风险模型分析死亡时间和死亡-技术失败时间。
在研究期间开始 PD 治疗的 3841 名患者中，有 2434 名（63%）可获得 pKt/V 测量值。这些患者根据其基线 pKt/V 值分为 4 组：<1.45（n = 599）、1.45-1.69（n = 550）、1.70-2.00（n = 607）和>2.00（n = 678）。与参考组（pKt/V 1.70-2.00）相比，pKt/V <1.45 的患者死亡率显著增加（校正后的危险比[HR] 1.87，95%置信区间[CI] 1.24-2.84；p = 0.003），而 pKt/V 1.45-1.69 的患者死亡率有增加趋势（校正 HR 1.46，95%CI 0.96-2.21；p = 0.074）。重要的是，较高的 pKt/V 值（>2.00）也与较高的死亡率相关（校正 HR 1.42，95%CI 0.96-2.11；p = 0.079）。死亡的其他独立预测因素包括较低的残余肾功能（RRF）、年龄较大、周围血管疾病、糖尿病、晚期转诊、较高的腹膜通透性和未经治疗的高血压。未观察到 pKt/V、RRF 和生存之间存在交互作用。pKt/V 1.45-1.69 组的死亡-技术失败率显著更高（校正 HR 1.36，95%CI 1.03-1.79；p = 0.028），年龄较大和亚裔患者的死亡-技术失败率也更高。
初始腹膜 Kt/V 显著且独立地影响澳大利亚和新西兰 PD 患者的生存情况。总体生存似乎在 pKt/V 范围 1.70-2.00 时最佳，在这些值以上和以下的生存情况较差。特别是，当实现的 pKt/V <1.45 时，生存情况明显恶化。此外，RRF 是澳大利亚和新西兰新发生 PD 患者人群中患者生存的重要独立预测因素。因此，本研究结果应引起人们对未向具有相当 RRF 的患者提供足够 PD 剂量可能带来的潜在危险的关注。
