Peritoneal dialysis adequacy

National Kidney Foundation. K/DOQI Clinical Practice Guidelines for peritoneal dialysis adequacy, 2000. Am J Kidney Dis 2001 (suppl 1) 37 S65-S136. 

National Kidney Foundation KDOQI Clinical practice guidelines and clinical practice recommendations for 2006 updates hemodialysis adequacy, peritoneal dialysis adequacy and vascular access. Am J Kidney Dis 2006 48(suppl) Sl S322. 

NKF KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates Hemodialysis Adequacy, Peritoneal Dialysis Adequacy and Vascular Access. Am J Kidney Dis 2006 48 S1-S322. 

Rodby RA, Firanek CA, Cheng YG, Korbet SM. 1996. Reproducibility of studies of peritoneal dialysis adequacy. Kidney Int-, 50(1) 267-271. 

Churchill D. Adequacy of dialysis and nutrition in continuous peritoneal dialysis association with clinical outcomes. Canada-USA (CANUSA) Peritoneal Dialysis Study Group. J Am Soc Nephrol 1996 7 198-207. 

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Friedlander MA, Rahman M, Tessman MJ, Hanshk TM, Ferrara KA, Newman LN. 1995. VariabOity in calculations of dialysis adequacy in patients using nightly intermittent peritoneal dialysis compared to CAPD. Adv Petit Dial 11 93-96. 

Keshaviah PR, Nolph KD, Van Stone JC.1989. The peak concentration hypothesis A urea kinetic approach to comparing the adequacy of continuous ambulatory peritoneal dialysis (CAPD) and hemodialysis. 

Ronco C, Bosch JP, Lew SQ et al. 1994. Adequacy of continuous ambulatory peritoneal dialysis Comparison with other dialysis techniques. Kidney Int-, 46(Suppl 48) S18-S24. 

An adjunct to the assessment of adequacy in PD patients is the peritoneal equilibration test (PET). The PET assesses peritoneal membrane transport characteristics in terms of solute clearances and ultrafiltration. The results are used to select a dialysis regimen appropriate to the transport characteristics of the patient (e.g., high transporters may do better on short dwell APD regimens). The PET is typically undertaken at the same time as adequacy assessments in PD patients. 

The K/DOQI clinical practice guidelines suggest that the adequacy of PD be assessed by using measured Kt/V and CEj three times in the first 6 months of dialysis (i.e., at months 1, 4, and 6). The reasoning behind this frequency is to accurately establish a baseline creatinine and urea excretion rate. Thereafter the KtA and Clcr should be measured every 4 months, at months 10, 14, and so on. The rationale for this is that it is imperative to detect subtle decreases in residual renal function and noncompliance and to make the necessary alterations to the prescribed PD dose to compensate for them. It is recommended that the first PET be conducted within the first month of treatment. Because solute clearance is dependent on peritoneal membrane transport properties, the guidelines also recommend that a PET be conducted within the first month of treatment. Future PET assessment is only recommended for patients with suspected changes in peritoneal membrane transport function, particularly when usual efforts to increase the PD dose are not successful. 

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