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[Focusing on peritoneal dialysis adequacy]. 2013
Belkacem Issad, and
Pierre-Yves Durand, and
Pascale Siohan, and
Eric Goffin, and
Joëlle Cridlig, and
Guillaume Jean, and
Jean-Philippe Ryckelynck, and
, and
W Arkouche, and
J-P Bourdenx, and
J Cridlig, and
B Dallaporta, and
H Fessy, and
M Fischbach, and
P Giaime, and
E Goffin, and
B Issad, and
G Jean, and
D Joly, and
L Mercadal, and
J-M Poux, and
J-P Ryckelynck, and
P Siohan, and
M Souid, and
D Toledano, and
C Verger, and
P Vigeral, and
M Uzan
Hôpital de la Pitié-Salpêtrière, centre hospitalier universitaire de Paris, 47/83, boulevard de l'Hôpital, 75013 Paris, France. Electronic address: belkacem.issad@psl.aphp.fr.
The optimal method to assess the adequacy of peritoneal dialysis therapies is controversial. Today, the adequacy must not be considered as a number or a concept assessed only by two parameters (total KT/V urea and total solute clearance) but defined by many more items. In the absence of data, based on theoretical considerations, the reanalysis of the CANUSA study showed that renal kidney function, rather than peritoneal clearance, was associated with improved survival. Residual renal function is considered as a major predictor factor of cardiovascular mortality. Results of this reanalysis were supported by the adequacy data in ADEMEX, EAPOS and ANZDATA studies. Therefore, clinical assessment plays a major role in PD adequacy. The management of fluid balance, the regular monitoring of malnutrition, the control of mineral metabolism and particularly the glucose load, considered as the "corner-stone" of the system, are the main points to be considered in the adequacy of PD patients. The essential goal is to minimize glucose load by glucose-sparing strategies in order to reduce the neoangiogenesis of the peritoneal membrane.
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