Defining peritoneal dialysis adequacy: Kt/Vurea revisited.

Abstract:

BACKGROUND:Although adequate peritoneal dialysis is not well defined, Kt/Vurea has been used as an index, and various values have been proposed. However, conflicting evidence existed regarding the appropriateness of using Kt/Vurea to define dialysis adequacy and its optimal value. Therefore, the present study performed a theoretical analysis on whether we should use Kt/Vurea to define peritoneal dialysis adequacy and what the optimal value should be. METHODS:The three-pore model was applied to evaluate the transport patterns of different molecular weight solutes and fluid. Optimal Kt/Vurea value was estimated based on urea kinetics and nitrogen balance. RESULTS:The removal pattern of small solute, middle and large molecules, and fluid and sodium are quite different. Depending on the dwell time, higher urea removal does not necessarily mean higher sodium, fluid, and other molecular weight solute removals. To reach nitrogen balance, the dialysis doses and therefore Kt/Vurea values varied with different dietary protein intakes in a patient with a given weight and residual renal function. CONCLUSION:This study shows that Kt/Vurea in peritoneal dialysis cannot represent the removal of other solutes and fluid, indicating that Kt/Vurea alone should not be used as a sole indicator of peritoneal dialysis adequacy. The results also show that optimal Kt/Vurea cannot be a fixed value, but varies according to individual dietary protein intake and tolerable blood urea level.

journal_name

Ren Fail

journal_title

Renal failure

authors

Zhe XW,Shan YS,Cheng L,Tian XK,Wang T

doi

10.1080/08860220601166586

subject

Has Abstract

pub_date

2007-01-01 00:00:00

pages

347-52

issue

3

eissn

0886-022X

issn

1525-6049

pii

778474946

journal_volume

29

pub_type

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