Quantifying Hernodialysis and Peritoneal Dialysis: Examination of the Peak Concentration Hypothesis

Summary In concert, the nonlinear effects and solute disequilibrium associated with hemodialysis may explain the differences between Kt/V required for patients receiving intermittent versus continuous dialysis who have a comparable average BUN. The above arguments may remove some of the mystery behind the benefits of CAPD, a form of dialysis that was discovered empirically and proved to be more successful than many would have predicted (6). To account for the surprising success of CAPD one need not postulate that uremic toxicity is related to high peak concentrations of urea, nor must one invoke an unknown effect of this type of dialysis; rather, the inefficiency of intermittent dialysis may be a sufficient explanation. When the factors that reduce the effectiveness of solute removal during hemodialysis are taken into account, these two forms of dialysis begin to look and behave similarly.