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.
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