Peritoneal dialysis adequacy: a paradigm shift

다국어 초록 (Multilingual Abstract)

For the past 30 years, nephrologists have focused on a single minimal threshold of Kt/Vurea to determine the adequacy of peritoneal dialysis (PD). To date, there is no evidence that shows Kt/Vurea to be a good surrogate measure of uremic symptom control or nutritional state in patients on PD. Volume of distribution (Vurea) generally is considered equivalent to total body water (TBW). Yet, accurate determination of TBW is difficult. The most recent International Society for Peritoneal Dialysis practice recommendations on prescribing high-quality PD emphasized incorporation of multiple measures rather than the single value of Kt/Vurea. These measures include shared decision-making between the patient and the care team and assessment of health-related quality of life, burden of uremic symptoms, presence of residual kidney function, volume status, and biochemical measures including serum potassium and bicarbonate levels. In some cases, PD prescriptions can be tailored to the patient priorities and goals of care, such as in frail and pediatric patients. Overall, there has been a paradigm shift in providing high-quality care to PD patients. Instead of focusing on small solute clearance in the form of Kt/Vurea, nephrologists are encouraged to use a more comprehensive assessment of the patient as a whole.

참고문헌 (Reference)

1 Wang AY, "Volume management as a key dimension of a high-quality PD prescription" 40 : 282-292, 2020

2 Xu Q, "Serum potassium levels and its variability in incident peritoneal dialysis patients : associations with mortality" 9 : e86750-, 2014

3 Stein A, "Role of an improvement in acid-base status and nutrition in CAPD patients" 52 : 1089-1095, 1997

4 Kim JK, "Repeated bioimpedance measurements predict prognosis of peritoneal dialysis patients" 47 : 120-129, 2018

5 Bargman JM, "Relative contribution of residual renal function and peritoneal clearance to adequacy of dialysis : a reanalysis of the CANUSA study" 12 : 2158-2162, 2001

6 Liao CT, "Rate of decline of residual renal function is associated with all-cause mortality and technique failure in patients on long-term peritoneal dialysis" 24 : 2909-2914, 2009

7 Guo Q, "Prevalence and risk factors of fluid overload in Southern Chinese continuous ambulatory peritoneal dialysis patients" 8 : e53294-, 2013

8 Hamad A, "Prevalence and management of hypokalemia in peritoneal dialysis patients in Qatar" 2019 : 1875358-, 2019

9 Warady BA, "Prescribing peritoneal dialysis for high-quality care in children" 40 : 333-340, 2020

10 Jansen MA, "Predictors of the rate of decline of residual renal function in incident dialysis patients" 62 : 1046-1053, 2002

11 Maiorca R, "Predictive value of dialysis adequacy and nutritional indices for mortality and morbidity in CAPD and HD patients : a longitudinal study" 10 : 2295-2305, 1995

12 Rocco M, "Peritoneal dialysis adequacy and risk of death" 58 : 446-457, 2000

13 Manera KE, "Patient and caregiver priorities for outcomes in peritoneal dialysis : multinational nominal group technique study" 14 : 74-83, 2019

14 Szeto CC, "Oral sodium bicarbonate for the treatment of metabolic acidosis in peritoneal dialysis patients : a randomized placebo-control trial" 14 : 2119-2126, 2003

15 National Kidney Foundation, "NKF-DOQI clinical practice guidelines for peritoneal dialysis adequacy" 30 (30): S67-S136, 1997

16 Menon MK, "Long-term blood pressure control in a cohort of peritoneal dialysis patients and its association with residual renal function" 16 : 2207-2213, 2001

17 Davenport A, "Is extracellular volume expansion of peritoneal dialysis patients associated with greater urine output?" 32 : 226-231, 2011

18 Brown EA, "International Society for Peritoneal Dialysis practice recommendations : prescribing high-quality goal-directed peritoneal dialysis" 40 : 244-253, 2020

19 Wang AY, "Important differentiation of factors that predict outcome in peritoneal dialysis patients with different degrees of residual renal function" 20 : 396-403, 2005

20 Szeto CC, "Hypokalemia in Chinese peritoneal dialysis patients : prevalence and prognostic implication" 46 : 128-135, 2005

21 Chuang YW, "Hypokalaemia : an independent risk factor of Enterobacteriaceae peritonitis in CAPD patients" 24 : 1603-1608, 2009

22 Finkelstein FO, "Health-related quality of life and adequacy of dialysis for the individual maintained on peritoneal dialysis" 40 : 270-273, 2020

23 Lo WK, "Guideline on targets for solute and fluid removal in adult patients on chronic peritoneal dialysis" 26 : 520-522, 2006

24 May RC, "Glucocorticoids and acidosis stimulate protein and amino acid catabolism in vivo" 49 : 679-683, 1996

25 Clegg A, "Frailty in elderly people" 381 : 752-762, 2013

26 Van Biesen W, "Fluid status in peritoneal dialysis patients : the European Body Composition Monitoring(EuroBCM)study cohort" 6 : e17148-, 2011

27 McCafferty K, "Extracellular volume expansion, measured by multifrequency bioimpedance, does not help preserve residual renal function in peritoneal dialysis patients" 85 : 151-157, 2014

28 Fan S, "Extracellular volume expansion in peritoneal dialysis patients" 35 : 338-345, 2012

29 Paniagua R, "Effects of increased peritoneal clearances on mortality rates in peritoneal dialysis : ADEMEX, a prospective, randomized, controlled trial" 13 : 1307-1320, 2002

30 Lo WK, "Effect of Kt/V on survival and clinical outcome in CAPD patients in a randomized prospective study" 64 : 649-656, 2003

31 Vashistha T, "Dialysis modality and correction of uremic metabolic acidosis : relationship with all-cause and cause-specific mortality" 8 : 254-264, 2013

32 Brown EA, "Delivering peritoneal dialysis for the multimorbid, frail and palliative patient" 40 : 327-332, 2020

33 Teitelbaum I, "Delivering high-quality peritoneal dialysis : what really matters?" 15 : 1663-1665, 2020

34 Mehrotra R, "Clinical utility of potassium-sparing diuretics to maintain normal serum potassium in peritoneal dialysis patients" (88) : S13-S25, 2003

35 Fülöp T, "Clinical utility of potassium-sparing diuretics to maintain normal serum potassium in peritoneal dialysis patients" 37 : 63-69, 2017

36 Tabinor M, "Bioimpedance-defined overhydration predicts survival in end stage kidney failure(ESKF) : systematic review and subgroup meta-analysis" 8 : 4441-, 2018

37 Canada-USA(CANUSA)Peritoneal Dialysis Study Group, "Adequacy of dialysis and nutrition in continuous peritoneal dialysis : association with clinical outcomes" 7 : 198-207, 1996

38 Poole-Wilson PA, "Acidosis and contractility of heart muscle" 87 : 58-76, 1982

39 Davies SJ, "Accuracy of the estimation of V and the implications this has when applying Kt/Vurea for measuring dialysis dose in peritoneal dialysis" 40 : 261-269, 2020