Adequacy of Peritoneal Dialysis after the ADEMEX Study. Back to the Basics

Ah, Tzamaloukas; Gh, Murata

doi:10.1177/039139880202500903

Cited by 3 publications

(4 citation statements)

References 28 publications

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“…ing what role small solute clearance plays in dialysis adequacy and the overall care of dialysis patients (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Section: On Small Solute Clearance and Patient Outcomes: Evidential Practice Or Observational Trepidation?mentioning

confidence: 99%

“…Indeed, earlier USA guidelines on peritoneal small solute clearance were driven by results from observational studies, and only more recently have these guidelines been revised to reflect results from RCTs and a reexamination of previous observational studies (21,22). Nevertheless, opinions on adequacy remain varied and questions persist regarding what role small solute clearance plays in dialysis adequacy and the overall care of dialysis patients (22-32). The study by Rumpsfeld et al., in this issue of Peritoneal Dialysis International , in which registry data from Australia and New Zealand are used to demonstrate a nonlinear relationship between small solute clearance, as measured by peritoneal Kt/V urea (pKt/V), and patient outcomes (mortality and technique failure) adds further to this ongoing debate (33).…”

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confidence: 99%

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On Small Solute Clearance and Patient Outcomes: Evidential Practice or Observational Trepidation?

Vonesh

2009

Perit Dial Int

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Recent guidelines on peritoneal dialysis adequacy set a minimum target for small solute clearance at Kt/V urea 1.70. While evidence from both observational studies and randomized controlled trials (RCTs) supports such a minimum target, there continues to be debate over what role small solute clearance plays in determining patient outcome. Current ANZDATA Registry results from Australia and New Zealand add fuel to this debate by demonstrating a significant nonlinear U-shaped relationship between peritoneal small solute clearance and patient survival. The ANZDATA results indicate that patients with too low or too high peritoneal Kt/V urea may be at significant risk of death compared to those with a peritoneal Kt/V urea between 1.70 and 2.00. As these results are somewhat at odds with results from published RCTs, we will examine the level of evidence from the observational setting that is the ANZDATA Registry and contrast it against the level of evidence from RCTs, particularly the ADEMEX trial. New results from the ADEMEX study are presented as a possible explanation for the paradoxical U-shaped results seen in the ANZDATA study.

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“…ing what role small solute clearance plays in dialysis adequacy and the overall care of dialysis patients (22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32).…”

Section: On Small Solute Clearance and Patient Outcomes: Evidential Practice Or Observational Trepidation?mentioning

confidence: 99%

mentioning

confidence: 99%

On Small Solute Clearance and Patient Outcomes: Evidential Practice or Observational Trepidation?

Vonesh

2009

Perit Dial Int

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“…The answer to this ambitious question needs to be equivocal and qualified. If by “success” is meant the prevailing guidelines were challenged (15,16), leading to their change, then ADEMEX was successful and its impact on the formulation of the new guidelines is broadly acknowledged (17-27). If by “success” is meant the strategy of therapy goals was altered from reliance on small solutes clearances to a broader scope that included fluid management and overall care optimization, then ADEMEX was successful (20,26,27).…”

Section: Was Ademex Successful In Altering the Face Of Pd Therapy?mentioning

confidence: 99%

“…The answer to this ambitious question needs to be equivocal and qualified. If by "success" is meant the prevailing guidelines were challenged (15,16), leading to their change, then ADEMEX was successful and its impact on the formulation of the new guidelines is broadly acknowledged (17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). If by "success" is meant the ance ≥60 L/week/1.73 m 2 ).…”

Section: Was Ademex Successful In Altering the Face Of Pd Therapy?mentioning

confidence: 99%