Key result
Continuous ambulatory peritoneal dialysis adequacy is best assessed by clinical outcomes, as biochemical and clearance parameters lack sensitivity and specificity.
Why the study?
How should the adequacy of continuous ambulatory peritoneal dialysis be assessed?
How should the adequacy of continuous ambulatory peritoneal dialysis be assessed?
Clinical outcomes remain the gold standard for assessing CAPD adequacy, highlighting the need for prospective multicenter studies to validate clearance parameters.
Answers are grounded in this paper and cite their sources.
Clinical outcomes should guide CAPD adequacy assessment; leaves open prospective validation of clearance parameters.
Adequacy of continuous ambulatory peritoneal dialysis (CAPD) and its variants is assessed by clinical outcomes, biochemical parameters and clearance parameters. Clinical outcomes lack specificity and probably sensitivity. Nevertheless, they constitute the "gold standard" to which any other method assessing dialysis adequacy must be compared. Biochemical parameters are both non-sensitive and non-specific and cannot be used to assess dialysis adequacy. Clearance of small molecular weight azotemic substances (urea, creatinine) presents considerable computational problems and interpretative difficulties. In preliminary studies, clearance studies have been able to differentiate between peritoneal dialysis patients having symptoms of inadequate dialysis and those clinically adequately dialyzed. Among population outcomes (morbidity, maintenance of peritoneal dialysis for long periods, hospitalization rate, mortality), only mortality seems to be associated with low clearances in retrospective studies. Prospective multicenter studies comparing clearance values to clinical outcomes are needed to evaluate clearance studies as methods of assessing peritoneal dialysis adequacy.
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Tzamaloukas et al. (1993) conducted a review in Continuous ambulatory peritoneal dialysis. Continuous ambulatory peritoneal dialysis (CAPD) was evaluated. Continuous ambulatory peritoneal dialysis adequacy is best assessed by clinical outcomes, as biochemical and clearance parameters lack sensitivity and specificity.
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