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Related Experiment Videos

CAPD prescription in current clinical practice

F Gotch1, D E Gentile, P Y Schoenfeld

  • 1Davies Medical Center, San Francisco, California.

Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis
|January 1, 1993
PubMed
Summary
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Peritoneal urea clearance (KpT) and renal urea clearance (KrT) were measured in 132 patients. Results suggest current dialysis adequacy criteria may overestimate patient outcomes, necessitating further clinical studies.

Area of Science:

  • Nephrology
  • Urology
  • Biomedical Engineering

Background:

  • Dialysis adequacy is crucial for patient outcomes in chronic kidney disease.
  • Current metrics may not fully capture the effectiveness of peritoneal dialysis.
  • Accurate assessment of urea clearance is essential for optimizing treatment.

Purpose of the Study:

  • To evaluate total urea clearance (KprT) in patients undergoing continuous ambulatory peritoneal dialysis (CAPD).
  • To compare calculated dialysis adequacy (KT/V) with existing consensus criteria.
  • To identify optimal ranges for KprT/V for effective CAPD.

Main Methods:

  • Measured peritoneal urea clearance (KpT) and renal urea clearance (KrT) over 24 hours in 132 patients across 15 dialysis centers.
  • Calculated total urea clearance (KprT), body water volume (V), and fractional urea clearance (KprT/V).

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  • Estimated normalized protein catabolic rate (PCRN) and equivalent thrice-weekly hemodialysis KT/V.

    • Main Results:

    • Renal urea clearance (KrT) accounted for 25% of total urea clearance (KprT).
    • Mean KprT/V was 0.28, with a wide range (0.10-0.50).
    • Calculated mean hemodialysis equivalent KT/V was 1.07, but 67% of patients had values below 1.0, contrasting with HCFA criteria indicating 91% adequacy.

    Conclusions:

    • Current dialysis adequacy criteria may not accurately reflect CAPD effectiveness.
    • There is a need for clinical outcome studies to define the optimal KprT/V range for CAPD.
    • Further research is required to establish better targets for peritoneal dialysis adequacy.