The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD )-2

Am J Kidney Dis. 2003 Jun;41(6):1293-302. doi: 10.1016/s0272-6386(03)00362-7.


Background: The guidelines from the US National Kidney Foundation Dialysis Outcomes Quality Initiative on peritoneal dialysis (PD) assume equivalence between the peritoneal and the renal solute clearance. The authors examined in a prospective cohort study of incident dialysis patients the relative contribution of residual renal function and peritoneal clearance to patient survival and quality of life (QoL).

Methods: The authors analyzed the longitudinal data on residual renal function, clearance by dialysis, and QoL of those patients who were treated with PD 3 months after the start of dialysis and participated in a prospective multicenter study in the Netherlands (n = 413).

Results: The mean age was 52 years, the mean residual glomerular filtration rate (rGFR) at 3 months was 4.1 mL/min/1.73 m2 (SD: 2.7), and the mean peritoneal creatinine clearance (pCrCl) at 3 months was 4.1 mL/min/1.73 m2 (SD: 1.1). The 2-year survival was 84%. For each mL/min/1.73 m2 increase in rGFR, a 12% reduction in mortality rate was found (relative risk of death [RR] = 0.88, P = 0.039). In contrast, no significant effect of pCrCl on patient survival was established (RR = 0.91, P = 0.47). The differential impact of rGFR and pCrCl was confirmed in an analysis on combined patient and technique survival and in an analysis on a number of generic and disease-specific dimensions of QoL.

Conclusion: The beneficial effect of renal clearance and the absence of an effect of peritoneal clearance in the range of values common in current practice on patient outcome indicate that the 2 components of total solute clearance should not be regarded as equivalent. Higher peritoneal clearance targets do not necessarily improve patient outcome.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Ascitic Fluid / chemistry
  • Cohort Studies
  • Creatinine / analysis*
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Kidney / physiopathology*
  • Kidney Failure, Chronic / mortality
  • Kidney Failure, Chronic / physiopathology*
  • Kidney Failure, Chronic / psychology
  • Kidney Failure, Chronic / therapy
  • Male
  • Metabolic Clearance Rate
  • Middle Aged
  • Netherlands / epidemiology
  • Peritoneal Dialysis* / psychology
  • Peritoneal Dialysis* / statistics & numerical data
  • Proportional Hazards Models
  • Prospective Studies
  • Quality of Life
  • Survival Analysis
  • Survival Rate
  • Treatment Outcome


  • Creatinine