The target and impact of Kt/V for Asian ESRD patients on haemodialysis

• Main Authors: Mohamad Nor, Fariz Safhan, Hamzah, Mohd Hazlan, Seman, Mohd Ramli, MK, Ahmad, Chan, Chee Eng, Draman, Che Rosle, Wan Ali, Wan Ahmad Syahril Rozli
• Format: Article
• Language: English
• Published: John Wiley & Sons, Inc. 2015
• Subjects: R Medicine (General)
• Online Access: http://irep.iium.edu.my/58941/6/vasc%20access%20and%20ktv%20ishd.pdf; http://irep.iium.edu.my/58941/; http://onlinelibrary.wiley.com/doi/10.1111/hdi.12368/full

INTRODUCTION The pathology of renal failure results in the deterioration of multiple physiologic, biochemical, and biologic bodily functions. Haemodialysis (HD) is the main method of therapy of reducing the damages, up to some extent. KT/V has long been used to measure the adequacy of haemodialysis, despite its limitations. It is still up to now a very useful and easy tool to measure the adequacy of HD. Earlier studies have also shown that KT/V is related to morbidity and mortality. The current recommended target for dialysis adequacy in HD patients is a KT/V of ≥ 1.2. However this recommendation is mainly based on using data from Western population. Even though there are studies to indicate that adult haemodialysis Asian patients experience similar or better intermediate outcomes compared to the Caucasians and African Americans, there is sparse data on the impact of KT/V on patient outcome in the general Asian haemodialysis population. OBJECTIVE This study is aimed at evaluating the impact of KT/V on patient outcome. METHOD This is a cross sectional study involving newly diagnosed End Stage Renal Disease (ESRD) patients initiating HD in the state of Pahang, Malaysia government dialysis centers between 1 January 2014 and 31 December 2014. Baseline demographics, initial dialysis access, dialysis access after 3 months, serum haemoglobin, albumin, calcium and phosphate levels, infection episodes, all causes hospitalisations and patient survival were recorded. The cohort of patients was divided into 3 groups based on the KT/V after 3 months of HD. RESULTS There were 123 cohorts in which 72 (58.5%) with Kt/V > 1.5 (group A), 31 (25.2%) with Kt/V 1.2 – 1.5 (group B) and 20 (16.3%) with Kt/V < 1.2 (group C). The mean age of our cohorts was 53.2 + 14.2 years old. The mean Kt/V was 1.69 + 0.5. Male patients were higher in group C compared to female patients, (27.3% vs 7.3%, p = 0.009) and the mean Kt/V for female was higher, (1.84 + 0.5 vs 1.57 + 0.4, p = 0.003). Central venous catheter (CVC) was used in 80.5% of cohorts at initiation of HD. After 3 months 60.2% were on arteriovenous fistula (AVF). There is no difference in age, races, initial and 6 months HD vascular access between the 3 groups. Group A has significantly higher serum albumin (39.1 + 3.1 g%) compared to group B (36.3 + 3.9 g%) and group C (34.6 + 3.5 g%) [p < 0.05]. Serum phosphate was higher in Group C (2.25 + 0.4 mmol/L) compared to group B (1.70 + 0.4 mmol/L) and group A (1.50 + 0.4 mmol/L). There were no significant difference in infection episodes, all cause hospitalizations and mortality between the 3 groups CONCLUSION Majority of patients achieved high Kt/V in our study. Increasing Kt/V is associated with better serum albumin and phosphate profile. However the impact on overall patient outcome including mortality is still not clear and may be explained by short duration of study. Further larger scale prospective studies may address the issue better.