Prescribing high-quality peritoneal dialysis: moving beyond urea clearance

Glavinovic, T; Hurst, HE; Hutchison, A; Johansson, L; Ruddock, N; Perl, J

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.

Citation

Glavinovic, T., Hurst, H., Hutchison, A., Johansson, L., Ruddock, N., & Perl, J. (2020). Prescribing high-quality peritoneal dialysis: moving beyond urea clearance. Peritoneal dialysis international, 40(3), https://doi.org/10.1177/0896860819893571

• Journal Article Type: Article
• Online Publication Date: Jan 17, 2020
• Publication Date: Jan 17, 2020
• Deposit Date: Nov 14, 2022
• Journal: Peritoneal Dialysis International: Journal of the International Society for Peritoneal Dialysis
• Print ISSN: 0896-8608
• Publisher: SAGE Publications
• Volume: 40
• Issue: 3
• DOI: https://doi.org/10.1177/0896860819893571
• Publisher URL: http://doi.org/10.1177/0896860819893571