Assessment of Peritoneal Dialysis Adequacy – Does it Impact on Patient Outcomes?

Abstract

The provision of adequate dialysis is important for the survival of Peritoneal Dialysis (PD) patients. Small solute clearance indices of urea and creatinine are widely used as markers of PD adequacy although several other factors are also known to affect optimal outcome in PD patients. Recently there is continued debate on the interpretation and precise prognostic value of small solute clearance in PD patients despite issuance of clinical practice guidelines and recommendations based on the solute clearance indices. We reviewed available literature on solute clearance indices in the assessment of PD adequacy and its association with patient outcome. Electronic data base such as the EMBASE, MEDLINE, OVID and Google internet search engines were used for the search as well as relevant textbooks. Several prospective cohort studies have been published on the effects of small solute clearance and other factors on mortality, morbidity and quality of life of PD patients. There are also some prospective controlled studies that used multivariate analysis to assess the relationship between solute clearance and other variables on patient outcomes. Randomised controlled studies however found that greater clearances did not lead to improved patient survival. Despite the continued debate on the interpretation and precise prognostic value of small solute clearance in PD
patients, dialysis recommendations based on the solute clearance have gained acceptance in clinical practice and a target dose of PD was recommended by National International organisations.