Is Target Kt/V and Patient Survival Different between Asian and Western Continuous Ambulatory Peritoneal Dialysis (Capd) Patients?

T he concept of adequacy of dialysis arose from the National Cooperative Dialysis Study (NCDS) re port on the impact ofKt/V urea and normalized protein catabolic rate (nPCR) on treatment failure in hemodialysis patients in 1985 (1). Clinical outcome is often the objective criterion for defining adequacy of dialysis, and it is usually measured as patient survival, or hospitalization rate, or both. Gotch and Sargent from the original NCDS re ported that Kt/V below 0.9 per treatment or 2.7 per week was associated with increased treatment failure. Subsequent data in hemodialysis confirmed the importance of small-solute clearance-usually in terms ofKt/V urea or urea reduction ratio-on pa tient survival (2,3). It is now widely accepted that the optimal Kt/V should be set at 1.2 to 1.4 per treat-ment and 1.4 to 1.6 for diabetic patients (3).