Vonesh E, Tebeau J, Dunham T, Moran J
Adequate dialysis is achievable among almost all anuric
peritoneal dialysis patients
17th Annual CAPD Conference
Perit Dial Int Suppl 1
(Feb) 17:S25 1997
This is essentially a modelling study in which Vonesh et al from
Baxter USA take data on 324 real anuric adult PD patients and see
whether present weekly clearance targets [KT/V 1.9, Cr Cl 60 liters]
can be reached using reasonable prescriptions. Therapies modelled
include CAPD with and without a night exchange device using 2.5 and 3L
volumes, and also APD using 2.5 and 3L dwell volumes as well as 2.5
and 3L wet days. The authors show that the overwhelming majority of
patients can achieve these targets, although it would require the use
of a 3L dwell volume and a night exchange device in many cases. It is
notable that strategies based on the night exchange device are more
successful than those based on APD. This emphasizes the point that
APD is not always a panacea for inadequate PD.
The authors' assumptions of course depend on the ability of patients
of only medium body surface area to tolerate 3L dwell volumes. In
reality, this is sometimes but not always feasible. One wonders if
even more patients could have achieved the targets if more than one
day dwell was used in association with an APD regimen but this was not
modelled. In general, the results are encouraging and suggest that
physical limitations to achieving clearance targets in PD may not be
as great as is sometimes suggested. It should again be emphasized,
however, that the efficacy of modelled prescriptions need to be
confirmed by actual clearance measurements. (Peter G. Blake,
M.D., Victoria Hospital, London, Ontario)
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