Comparison between DOQI and Canadian guidelines for peritoneal dialysis

Area of Science:

• Nephrology
• Dialysis Therapy

Background:

• The Canadian Society of Nephrology (CSN) and US National Kidney Foundation Dialysis Outcomes Quality Initiative (DOQI) have published guidelines for peritoneal dialysis (PD) adequacy.
• These guidelines present notable divergences in targets and recommendations.

Purpose of the Study:

• To analyze the key differences between the CSN and DOQI guidelines for peritoneal dialysis adequacy.
• To explore the rationale behind these discrepancies, considering new evidence and influencing factors.

Main Methods:

• Comparative analysis of the CSN and DOQI guidelines for peritoneal dialysis adequacy.
• Review of available scientific literature and consideration of clinical opinion and economic factors.

Main Results:

• CSN guidelines use uniform targets for continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD), unlike DOQI's higher APD targets.
• CSN differentiates creatinine clearance (CCr) targets based on transporter status, a distinction absent in DOQI.
• CSN incorporates both lower limit and preferred targets for Kt/V and CCr, with less emphasis on Kt/V primacy over CCr compared to DOQI.
• CSN guidelines place greater emphasis on the risks associated with high transporter status.

Conclusions:

• Differences in PD adequacy guidelines stem from updated information, differing emphasis on evidence versus opinion, and potential geographic/economic influences.
• The CSN guidelines reflect a nuanced approach to PD adequacy, considering transporter characteristics and risk stratification.