title: Dialysis adequacy targets in continuous ambulatory peritoneal dialysis--higher is not necessarily better.
abstract: Evidence for the recommendations by the Dialysis Outcomes Quality Initiative (DOQI) on peritoneal dialysis targets was obtained largely from observational studies showing improvement of clinical outcome with higher Kt/V. Recently published interventional studies--including the ADEMEX study and several studies from Asia--did not show significant improvement of outcome with increased peritoneal Kt/V or creatinine clearance. The possible reasons for lack of improvement might include the limitations of increased dialysis with regard to middle-molecule clearance and the harmful effects of excessive dialysis. The body of evidence suggests that a total Kt/V below 1.7 is associated with a poorer outcome. A minimal Kt/V target of 1.7 is suggested, with the dialysis prescription also being guided by other clinical parameters.
authors.affiliation: Department of Medicine, Tung Wah Hospital, Hong Kong SAR, China. wkloc@hkucc.hku.hk
authors.forename: Wai Kei
authors.initials: WK
authors.lastname: Lo
mesh_terms: D006801:Humans; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000592:standards*