The ADEMEX study and PD adequacy

Abstract

The ADEMEX study was a prospective, randomized, controlled, interventional trial that evaluated the effect of an increase in peritoneal clearance on the relative risk of death for patients on CAPD. The results suggest that over the range of solute clearance studied, increasing peritoneal solute clearance had no beneficial effect on survival. Residual renal function did predict outcome. The findings are clinically relevant, but there are some limitations of the study that may limit the generalizability of the results. First of all, exclusion criteria were likely to result in the exclusion of rapid transporters and small patients, the subgroup of patients found to have an increased relative risk of death on PD in other studies. Secondly, ADEMEX evaluated the effect of an increase in small solute, not middle molecular weight solute clearances on outcome. Lastly, ADEMEX did not evaluate outcomes for patients on cycler therapies, the most popular form of PD in use currently. The data confirms (a) that one size prescription does not fit all; (b) that many patients below current NKF-DOQI targets for small solute clearance may be adequately dialyzed, and (c) it provides us with evidence-based data that national societies can consider using when preparing for the next revisions of their guidelines.