Implications of the ADEMEX Trial

Mujais, Salim; Vonesh, Edward F.; Abu‐Alfa, Ali K.

doi:10.1159/000071433

Cited by 4 publications

(14 citation statements)

References 38 publications

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“…Because of the importance of the issue of dialysis dose in current nephrologic discourse [40,44], we undertook a very detailed and rigorous evaluation of the effects of small solutes clearances on parameters of HRQOL. Both unadjusted and adjusted analysis were carried out comparing mean scores of KDQOL domains and summary scores between control and intervention groups at each follow-up of 6, 12, and 24 months.…”

Section: Discussionmentioning

confidence: 99%

“…While most studies have failed to show a survival benefit of increasing peritoneal small solute clearances beyond a range currently practiced [40][41][42][43][44][45], it has been speculated that increasing peritoneal clearances may improve other important outcome measures, such as patient HRQOL. A randomized, prospective, controlled clinical trial is required to substantiate the presence or absence of a potential HRQOL effect from a high peritoneal clearance.…”

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confidence: 99%

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Health-related quality of life predicts outcomes but is not affected by peritoneal clearance: The ADEMEX trial

Paniagua¹,

Amato²,

Vonesh³

et al. 2005

Kidney International

100

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Health-related quality of life predicts outcomes but is not affected by peritoneal clearance: The ADEMEX trial

Paniagua¹,

Amato²,

Vonesh³

et al. 2005

Kidney International

100

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“…Damit wurde aber das breitgefächerte Spektrum der adäquaten Dialyse auf wenige Aspekte reduziert [20].…”

Section: Die Doqi-guidelineseinschränkungen Und Problemeunclassified

“…Die Autoren haben angenommen, dass eine Steigerung des Ziel-Kt/V im "Dezimal"-Bereich ausreicht, um die durch intermittierende Cyclertherapie vorhandenen Schwankungen der Konzentration der Urämietoxine und die dadurch schlechtere Dialysequalität zu kompensieren [20]. Dies wurde aber nie durch klinische Studien bestätigt.…”

Section: Die Doqi-guidelineseinschränkungen Und Problemeunclassified

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Adäquate Peritonealdialyse – neue Richtlinien?

Lilaj

2005

Wien Klin Wochenschr

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The role of peritoneal dialysis (PD) in renal replacement therapy has been well established. However, there is persisting controversy about the amount of dialysis that is required for optimal outcome. On the basis of the results of clinical studies of patients treated with continuous ambulatory peritoneal dialysis (CAPD), NFK-DOQI guidelines recommended achieving a Kt/Vurea of >or=2.0 per week and a total creatinine clearance of >or=50 l/week/1.73 m2 (low/low-average transporters) to 60 l/week/1.73 m2 (high/high-average transporters). In automated PD, the targets are slightly higher (>or=2.1 per week and >or=63 l/week/1.73 m2, respectively). In the DOQI guidelines, renal and peritoneal clearances are assumed to be equivalent; therefore it has been supposed that increasing the dialysis dose could compensate for the loss of residual renal function (RRF). Several retrospective studies analyzed the effect of peritoneal and renal clearances separately and did not find a correlation between peritoneal small-solute clearance and mortality. However, RRF was an important factor influencing mortality of PD patients. The Adequacy of Peritoneal Dialysis in Mexico (ADEMEX) study is a randomized, prospective study that was designed to investigate the effect of PD dose on clinical outcome in CAPD patients. This study also showed that RRF, but not peritoneal clearance, predicted clinical outcome. An increase of PD dose (from 1.8 to 2.27 Kt/V per week) did not improve patient survival or technique survival. On the basis of the result of ADEMEX and some other clinical studies, a combined renal and peritoneal Kt/V of 1.8/week appears to be adequate in most clinically stable PD patients without signs of malnutrition. Nevertheless, there are no patient-survival data on the influence of peritoneal small-solute clearances, which are markedly higher than those recommended in the DOQI guidelines. On the other hand, important determinants of adequate PD include not only small-solute clearances but also middle-molecule clearances, preservation of RRF, careful attention to volume status, treatment of cardiovascular risk factors, and treatment of malnutrition and other comorbidities.

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Ademex: The Evidence and the Nephrosopher

Mujais

Vonesh

2007

Perit Dial Int

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Implications of the ADEMEX Trial

Cited by 4 publications

References 38 publications

Health-related quality of life predicts outcomes but is not affected by peritoneal clearance: The ADEMEX trial

Health-related quality of life predicts outcomes but is not affected by peritoneal clearance: The ADEMEX trial

Adäquate Peritonealdialyse – neue Richtlinien?

Ademex: The Evidence and the Nephrosopher

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