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Published on: July 20, 2022
Adequacy targets in peritoneal dialysis
1Department of Renal Medicine, Manchester Royal Infirmary, Manchester, UK.
Abstract:
Adequate solute and fluid removal are the cornerstones of dialysis treatment. In peritoneal dialysis, what constitutes adequate removal, has been hitherto controversial, based as it was on DOQI guidelines. There are now 2 randomised controlled trials that address solute removal--both indicate that the minimal Kt/V needs to be 1.7. This needs to be adjusted in individual cases based on clinical and other parameters. Fluid removal and blood pressure control are also important adequacy parameters. Sub-clinical fluid overload is a common feature and relates to left ventricular hypertrophy. This also needs addressing but estimating fluid status is difficult.
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Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...
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