Peritoneal Solute tranSPort in Peritoneal DialySiS PatientS: longituDinal ChangeS anD influenCe on Survival

Background: Peritoneal dialysis (PD) patients have a higher mortality rate than the general population. This study aimed to evaluate the longitudinal changes of peritoneal solute transport and its influence on the prediction of survival in PD patients. Methods: This is a single center retrospective study on patients commencing PD between January 1992 and September 2004, and staying in treatment for at least one year until the end of the study period in September 2005. Patients were evaluated by peritoneal equilibration test (PET) with the 4-h dialysate/plasma creatinine ratio (D/Pcrea) within three months after initiation of dialysis and at one-year intervals. Result: The variation between D/Pcrea at one year and mean D/Pcrea was significantly less than that between initial D/Pcrea and mean D/Pcrea. Upon Cox proportional hazards, age, gender, diabetes mellitus, cardiovascular disease (CVD), residual renal function, normalized protein catabolic rate, albumin, D/Pcrea at one year and cardiothoracic ratio (CTR) were significantly associated with mortality. Multivariate analysis showed the presence of CVD, lower serum albumin concentration, older age, and higher D/Pcrea at one year were the independent predictors of mortality. Conclusion: Longitudinal changes in peritoneal solute transport occurred in early course of PD. A stable D/Pcrea at one year, instead of initial D/Pcrea, is an independent prognostic factor for PD patients surviving more than one year. (Acta Nephrologica 2007; 21: 195-200)