Prescribing high-quality peritoneal dialysis: Moving beyond urea clearance. Issue 3 (May 2020)

• Record Type: Journal Article
• Authors: Glavinovic, Tamara; Hurst, Helen; Hutchison, Alastair; Johansson, Lina; Ruddock, Nicola; Perl, Jeffrey
• Other Names: Brown Edwina guest-editor.
• Is Part Of: Peritoneal dialysis international. Volume 40:Issue 3(2020)
• Page Start: 293
• Page End: 301
• Publication Date: 2020-05
• Subjects: Albumin -- hypoalbuminaemia -- nutrition -- peritoneal dialysis -- peritoneal dialysis adequacy -- peritoneal protein clearance -- phosphorus -- potassium -- protein-energy wasting -- small solutes -- uraemic toxins -- urea clearance; Peritoneal dialysis -- Periodicals; Continuous ambulatory peritoneal dialysis -- Periodicals; 617.461059
• DOI: 10.1177/0896860819893571
• Languages: English
• ISSNs: 0896-8608

Abstract

Urea removal in peritoneal dialysis (PD) has been a primary measure of dialysis adequacy, but its utility remains limited due to its poor correlation with the clearance of other important uraemic retention solutes and the low certainty of evidence relating peritoneal urea clearance and survival of individuals doing PD. Indeed, clearances of other uraemic solutes, electrolyte imbalances, hypoalbuminaemia and nutritional status, may provide a more holistic measure of dialysis adequacy when evaluating individuals on PD in addition to focusing on person-centred outcomes. Here, we review the history of the urea and creatinine-centric approach to dialysis adequacy and explore the potential importance of other uraemic retention solutes, electrolyte disturbances, phosphorus control, peritoneal protein losses and hypoalbuminaemia, as well as nutritional management to promote a broader multidimensional concept of clearance for PD.