Adequacy in Peritoneal Dialysis

Guideline Organization

Recommendation (Evidence Level)

Evidence

Comments

CARI-Australia
2005

- For CAPD and APD the weekly Kt/V target should be > 1.6/week. The minimum weekly CCr target should be 60L/week in high and high average transporters and 50L/week in low average and low transporters. (Level II)
- PD adequacy should involve various measurements including clinical assessment of wellbeing, physical measurements, small solute clearance, fluid removal, and impact of treatment on the individual’s life. Small solute clearance measurements should be interpreted in the context of all clinical and lab assessments of dialysis adequacy. Measured clearances that fall short of the recommended targets should not necessarily be interpreted as providing inadequate dialysis, and measured clearances in the excess of the recommended targets should not necessarily be viewed as representing adequate dialysis. (Level III-IV)
- These recommendations need to be modified with patients of low or excessive BMI. For patients with a BMI > 27.5kg/m2, normalised clearance values may be difficult to achieve. Adequacy needs to be interpreted in the context of body size. (Level III-IV)
- The impact of residual renal function appears to be an important determinant of outcome. The contribution of a falling RRF to clearance targets needs to be assessed in the clinical context of the patient’s wellbeing, fluid status, nutritional status, as well as tolerance of the dialysis prescription. (Level III-IV)
 

Dialysis Adequacy (PD).
7. Small solute clearance targets in peritoneal dialysis.



8. Monitoring patients on peritoneal dialysis.

CSN-Canada
1999

- For CAPD en APD Kt/V should be > 2.0/week or CCr>60L/week in high and high average transporters and >50L/week in low and low average transporters. (Opinion)
- Kt/V <1.7 and CCr <50L/week should be considered unacceptable.
- Apply all clearance targets in the context of the patient’s personal and clinical circumstances.
(RATIONALE)
 

Guideline 5.1 Target Clearances in Peritoneal Dialysis
Guideline 5.2 Clearance measurements in PD
P 25-26 of 35 PDF pages

It is acceptable that a patient can only achieve one of the two targets.
Monitor Kt/V and CCr with 24H collections of urine and dialysate within 6 to 8 weeks and every 6 months.
If the patient’s clinical status or prescription is altered, take new clearance measurements.

EBPG-Europe
Peritoneal Dialysis
2005

- The minimum peritoneal target for Kt/V in anuric patients is a weekly value of 1.7 (Level A); the minimum target for net ultrafiltration in anuric patients is 1.01/day (Level B).
The presence of residual renal function can compensate when these targets are not achieved. (Level C)

Adequacy of peritoneal dialysis

KDOQI-US

Peritoneal Dialysis Adequacy
(2006)

For patients with RKF (considered to be significant when urine volume is > 100 mL/d):

• The minimal “delivered” dose of total small-solute clearance should be a total (peritoneal and kidney) Kt/Vurea of at least 1.7 per week. (B)
• Total solute clearance (residual kidney and peritoneal, in terms of Kt/Vurea) should be measured within the first month after initiating dialysis therapy and at least once every 4 months thereafter. (B)
• If the patient has greater than 100 mL/d of residual kidney volume and residual kidney clearance is being considered as part of the patient's total weekly solute clearance goal, a 24-hour urine collection for urine volume and solute clearance determinations should be obtained at a minimum of every 2 months. (B)

 
For patients without RKF (considered insignificant when urine volume is ≤100 mL/d):

• The minimal “delivered” dose of total small-solute clearance should be a peritoneal Kt/Vurea of at least 1.7 per week measured within the first month after starting dialysis therapy and at least once every 4 months thereafter. (B)

 (RATIONALE)

PERITONEAL DIALYSIS SOLUTE CLEARANCE TARGETS AND MEASUREMENTS 

UK-Guidelines

Module 3B: Peritoneal Dialysis
2007

- Both residual urine and peritoneal dialysis components of small solute clearance should be measured at least six monthly or more frequently if clinically indicated. Both urea and/or creatinine clearances can be used to monitor dialysis adequacy and should be interpreted within the limits of the methods. (Level B)
- A combined urinary and peritoneal Kt/Vurea of >1.7/week or a creatinine clearance of >50L/week/1.73m2 should be considered as minimal treatment doses. The dose should be increased in patients experiencing uraemic symptoms.
(RATIONALE)

Solute Clearance