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COMMENTARIES |
Northwestern University Chicago, Illinois, USA
e-mail: e-vonesh{at}northwestern.edu
ABSTRACT
Recent guidelines on peritoneal dialysis adequacy set a minimum target
for small solute clearance at Kt/V urea 1.70. While evidence from both
observational studies and randomized controlled trials (RCTs) supports such a
minimum target, there continues to be debate over what role small solute
clearance plays in determining patient outcome. Current ANZDATA Registry
results from Australia and New Zealand add fuel to this debate by
demonstrating a significant nonlinear U-shaped relationship between peritoneal
small solute clearance and patient survival. The ANZDATA results indicate that
patients with too low or too high peritoneal Kt/V urea may be at significant
risk of death compared to those with a peritoneal Kt/V urea between 1.70 and
2.00. As these results are somewhat at odds with results from published RCTs,
we will examine the level of evidence from the observational setting that is
the ANZDATA Registry and contrast it against the level of evidence from RCTs,
particularly the ADEMEX trial. New results from the ADEMEX study are presented
as a possible explanation for the paradoxical U-shaped results seen in the
ANZDATA study.
KEY WORDS: Patient survival; observational studies; randomized controlled trials; Kt/V urea.
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