Nephrol Dial Transplant (2002) 17: 970-972
© 2002 European Renal Association-European Dialysis and Transplant Association
Editorial Comments
The rise and fall of the Kt/V concept in CAPD
Division of Nephrology, Department of Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
Introduction
A simple figure to quantify the dialysis dose is attractive by all means. It facilitates the dialysis prescription and allows to study effects of the dialysis dose on outcome. Kt/Vurea as developed by Gotch et al. for haemodialysis, meets this requirement because essentially it means that large patients need more dialysis, either by a higher urea clearance or by a longer treatment time, than small patients do [1]. The disadvantage of Kt/Vurea is that only the clearance of urea is taken into account, one of the smallest uraemic toxins, while no attention is paid to the removal of the so-called ‘middle-molecules’ and of excess of body fluid.
Peritoneal dialysis is different from haemodialysis, because the peritoneal clearance of low molecular weight solutes is much lower than in haemodialysis while that of middle-molecules is higher. For instance, the average peritoneal urea clearance in CAPD is
Retrospective studies
Prospective cohort studies
How solid is the evidence?
The ADEMEX study
Conclusion
Notes
References