Ademex: The Evidence and the Nephrosopher

Should we look beyond Kt/V urea in assessing dialysis adequacy?

“…Although the importance of Kt/V in PD had arguably been losing emphasis, its use is still being recommended. As Mujais observed: "the evidence was inconsistent with prevailing bias" 44.…”

On Small Solute Clearance and Patient Outcomes: Evidential Practice or Observational Trepidation?

“…The ANZDATA study by Rumpsfeld and colleagues provides what I believe is supportive evidence for current practice guidelines as published in the KDOQI guidelines and elsewhere (21). Despite some of the limitations and questions their study raises, the authors rightly “draw attention to the possible danger of not delivering adequate peritoneal dialysis dose to patients with considerable residual renal function.” But lest we forget, the adequacy of dialysis entails much more than simply dialyzing to a single measure such as pKt/V, a point made repeatedly in commentaries regarding the ADEMEX study (22,43). What the ADEMEX, ANZDATA, and other studies of small solute clearance have shown is that there is a therapeutic range of pKt/V values coinciding with a range of serum urea levels within which population-based patient survival is similar.…”