Solute clearance approach to adequacy of peritoneal dialysis

To investigate the effect of dialysis prescription on patient outcome for peritoneal dialysis patients, the relationship between total solute clearance and the relative risk of death has been investigated. Preliminary studies have suggested that more clearance is better and that patient outcome is predicted by total solute clearance. The recently published Canada-U.S.A. (CANUSA) multicenter study, evaluating adequacy of dialysis and nutrition in peritoneal dialysis patients, has further defined this relationship. Although these publications allow us to establish guidelines for the treatment of peritoneal dialysis patients, they also define the limitation of our knowledge and raise new questions. In this article we review our current knowledge regarding the predicted value of total solute clearance with patient outcome and nutritional status. Furthermore, we attempt to outline a practical approach for optimizing total solute clearance in peritoneal dialysis patients. Based on a review of the published literature and clinical recommendations, we feel that the minimal target total solute clearance for continuous forms of peritoneal dialysis is a weekly total KT/V > 2.0 and/or a weekly total creatinine clearance > 60 L/week/1.73 m2. For intermittent therapies, a weekly total KT/V > 2.2 and/or a weekly total creatinine clearance > 70 L/week/1.73 m2 is recommended.