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      The ADEMEX Study and PD Adequacy

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          The ADEMEX study was a prospective, randomized, controlled, interventional trial that evaluated the effect of an increase in peritoneal clearance on the relative risk of death for patients on CAPD. The results suggest that over the range of solute clearance studied, increasing peritoneal solute clearance had no beneficial effect on survival. Residual renal function did predict outcome. The findings are clinically relevant, but there are some limitations of the study that may limit the generalizability of the results. First of all, exclusion criteria were likely to result in the exclusion of rapid transporters and small patients, the subgroup of patients found to have an increased relative risk of death on PD in other studies. Secondly, ADEMEX evaluated the effect of an increase in small solute, not middle molecular weight solute clearances on outcome. Lastly, ADEMEX did not evaluate outcomes for patients on cycler therapies, the most popular form of PD in use currently. The data confirms (a) that one size prescription does not fit all; (b) that many patients below current NKF-DOQI targets for small solute clearance may be adequately dialyzed, and (c) it provides us with evidence-based data that national societies can consider using when preparing for the next revisions of their guidelines.

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          Effect of fluid and sodium removal on mortality in peritoneal dialysis patients.

          Effect of fluid and sodium removal on mortality in peritoneal dialysis patients. Adequacy of peritoneal dialysis (PD) traditionally is assessed using Kt/V(urea) and total creatinine clearance (TCC). However, this approach underestimates the importance of fluid and sodium removal. The aim of this study was to determine the effect of fluid and sodium removal on morbidity and mortality in PD patients. One hundred twenty-five PD patients were monitored for three years from the beginning of the treatment. The effects of demographic features, comorbidity, peritonitis rate, blood pressure, medications, blood biochemistry, peritoneal membrane transport characteristics, residual renal function (RRF), Kt/V(urea), TCC, normalized protein nitrogen appearance (nPNA), and removal of sodium and fluid on mortality were evaluated. Total and cardiovascular hospitalization rates were also recorded. A Cox proportional hazards model was used to determine factors predicting mortality. In the Cox model, comorbidity, total sodium and fluid removals, hypertensive status, serum creatinine, and RRF were independent factors affecting survival. In contrast, Kt/V(urea) or TCC did not affect the adjusted survivals. Total sodium and fluid removal and hypertensive status also significantly influenced the hospitalization rate. Systolic and diastolic blood pressures were negatively correlated with total fluid (P < 0.001) and sodium removal (P < 0.001). Together, these findings suggest that removal of sodium and fluid is a predictor of mortality in PD patients, whereas Kt/V(urea) and TCC are not factors. Adequate fluid and sodium balance is crucial for the management of patients on PD.

            Author and article information

            Blood Purif
            Blood Purification
            S. Karger AG
            22 January 2003
            : 21
            : 1
            : 37-41
            Wake Forest University Baptist Medical Center, Winston-Salem, N.C., USA
            67870 Blood Purif 2003;21:37–41
            © 2003 S. Karger AG, Basel

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            References: 14, Pages: 5
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