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February 11, 2004

Underutilization of Peritoneal Dialysis

Author Affiliations

Author Affiliation: Department of Nephrology, Herlev University Hospital, Herlev, Denmark.

JAMA. 2004;291(6):740-742. doi:10.1001/jama.291.6.740

Considerable progress has been made during the past decade in the practice and theory of peritoneal dialysis for end-stage renal disease (ESRD). One previous major concern was whether peritoneal dialysis could deliver enough clearance to meet targets for adequacy of dialysis. Patients can be divided into low and high peritoneal transport categories depending on measured clearance rates.1 Anuric "low transporters" were considered at particular risk for underdialysis. However, epidemiological studies showed paradoxically lower morbidity and mortality in this group.2 High transporters, while easily achieving conventional dialysis targets, were characterized by ultrafiltration failure (due to rapid loss of glucose, and thereby osmotic pressure, from the dialysis fluid), hypertension, excess peritoneal loss of albumin, and excess mortality.