title: [Focusing on peritoneal dialysis adequacy].
abstract: 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.
authors.affiliation: 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.
authors.forename: Belkacem
authors.initials: B
authors.lastname: Issad
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Durand
authors.forename: Pascale
authors.initials: P
authors.lastname: Siohan
authors.forename: Eric
authors.initials: E
authors.lastname: Goffin
authors.forename: Joëlle
authors.initials: J
authors.lastname: Cridlig
authors.forename: Guillaume
authors.initials: G
authors.lastname: Jean
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Ryckelynck
authors.forename: W
authors.initials: W
authors.lastname: Arkouche
authors.forename: J-P
authors.initials: JP
authors.lastname: Bourdenx
authors.forename: J
authors.initials: J
authors.lastname: Cridlig
authors.forename: B
authors.initials: B
authors.lastname: Dallaporta
authors.forename: H
authors.initials: H
authors.lastname: Fessy
authors.forename: M
authors.initials: M
authors.lastname: Fischbach
authors.forename: P
authors.initials: P
authors.lastname: Giaime
authors.forename: E
authors.initials: E
authors.lastname: Goffin
authors.forename: B
authors.initials: B
authors.lastname: Issad
authors.forename: G
authors.initials: G
authors.lastname: Jean
authors.forename: D
authors.initials: D
authors.lastname: Joly
authors.forename: L
authors.initials: L
authors.lastname: Mercadal
authors.forename: J-M
authors.initials: JM
authors.lastname: Poux
authors.forename: J-P
authors.initials: JP
authors.lastname: Ryckelynck
authors.forename: P
authors.initials: P
authors.lastname: Siohan
authors.forename: M
authors.initials: M
authors.lastname: Souid
authors.forename: D
authors.initials: D
authors.lastname: Toledano
authors.forename: C
authors.initials: C
authors.lastname: Verger
authors.forename: P
authors.initials: P
authors.lastname: Vigeral
authors.forename: M
authors.initials: M
authors.lastname: Uzan
mesh_terms: D012080:Chronic Kidney Disease-Mineral and Bone Disorder / Q000503:physiopathology; D005919:Glomerular Filtration Rate / Q000502:physiology; D005947:Glucose / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D044342:Malnutrition / Q000175:diagnosis / Q000503:physiopathology / Q000517:prevention & control; D008657:Metabolic Clearance Rate / Q000502:physiology; D010530:Peritoneal Dialysis / Q000379:methods*; D010710:Phosphates / Q000378:metabolism; D014882:Water-Electrolyte Balance
chemical_list: D010710:Phosphates; D005947:Glucose
keywords: Adequacy; Adéquation; Balance hydrosodée; Clairance des solutés; Clearances assessment; Dialyse péritonéale; Fluid balance; Glucose sparing strategies; KT/V urée; Malnutrition; Mineral bone disease; Peritoneal dialysis; Stratégies d’épargne en glucose