The rise and fall of the Kt/V concept in CAPD

The Ademex Study: Afterthoughts

“…This hypothesized relationship between small solute clearance and survival is depicted in Figure 1 and was presented for the first time by Dr. John Burkart at the ISPD Congress (Montreal, 2001) when he commented on the ADEMEX study. Beyond the fact that this would be a very atypical dose-response curve, the explanation sticks to the concept that small solute clearance is the best marker of dialysis dose, which is now under scrutiny and raising serious doubts (4,20,21). Moreover, even if there were a break point after a plateau in the relationship between dialysis dose and survival, interest in it would be more theoretical than practical, since it would be very difficult to achieve peritoneal small solute clearances higher than those reached in the ADEMEX trial using currently available technology.…”