Peritoneal dialysis adequacy and risk of death

The debate on the relationship between small solute clearance and patient outcome on peritoneal dialysis has intensified in the past year with the publication or presentation of a number of important new studies. Previous studies had found a correlation between clearances and subsequent patient survival. However, this effect was all accounted for by residual renal clearance. The failure to detect an independent effect of peritoneal clearance on outcomes had been attributed to a lack of well-done studies with sufficient variation in peritoneal clearance to detect such an effect. New prospective and randomized studies suggest, however, that the relationship between peritoneal clearance and outcome is weak or absent within the usual dose ranges delivered in clinical practice. Existing clearance targets may need to be reviewed.