The ADEMEX study in this issue of the Journal concludes that currently recommended adequacy guidelines require more peritoneal dialysis. PDF | On Jul 1, , Dante Amato and others published The ADEMEX study: afterthoughts. Abstract. The ADEMEX study was a prospective, randomized, con- trolled, interventional trial that evaluated the effect of an increase in peritoneal clearance on.
CitePeer Related Articles http: The minimal follow-up period was 2 yr. Small-solute clearance targets for peritoneal dialysis PD have been based on the tacit assumption that peritoneal and renal clearances are equivalent and therefore additive.
Although several studies have established that patient survival is directly correlated with renal clearances, there have been no randomized, controlled, interventional trials examining the effects of increases in peritoneal small-solute clearances on patient survival. A prospective, randomized, controlled, clinical trial was performed to study the effects of increased peritoneal small-solute clearances on clinical outcomes among patients with end-stage renal disease who were being treated with PD.
As a result there has been a shift away from interest in peritoneal small solute clearance with renewed interest in peritoneal removal of salt and water. No clear survival advantage was adejex with increases in aademex small-solute clearances within the range achieved in this study.
This review examines the results of the ADEMEX Adequacy of Peritoneal Dialysis in Mexico study in the context of other recent advances in peritoneal dialysis, and assesses the implication of this new knowledge for the optimal peritoneal dialysis stufy.
Read Article at publisher’s site. Secondly, ADEMEX evaluated the effect of an increase in small solute, not middle molecular weight solute clearances on outcome. Residual renal function did predict outcome.
Subjects in the control group continued to receive their preexisting PD prescriptions, which consisted of four daily exchanges with 2 L of standard PD solution. A total of subjects were randomly assigned to the intervention or control group in a 1: The prospective randomized controlled ADEMEX study demonstrated no survival advantage of an increased dose of peritoneal small molecule clearance delivered by chronic ambulatory peritoneal dialysis.
The findings are clinically relevant, but there are some limitations of the study that may limit the generalizability of the results.
Current Opinion in Nephrology and Hypertension [01 Nov12 6: This has resulted in de-emphasis of peritoneal small molecule clearance and increased emphasis on clinical assessment of dialysis adequacy, preservation of residual renal function, and optimization of salt and water removal.
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. The ADEMEX study and subsequent investigations have changed the way we perceive the optimal peritoneal dialysis prescription.
The data confirms a aademex 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.
The results suggest that over the range of solute stury studied, increasing peritoneal solute clearance had no beneficial effect on survival. The study groups were similar with respect to demographic characteristics, causes of renal disease, prevalence of coexisting conditions, residual renal function, peritoneal clearances before intervention, hematocrit values, and multiple indicators of nutritional status. Mortality rates stduy the two groups remained similar even after adjustment for factors known to be associated with survival for patients undergoing PD e.
The primary endpoint was death. Find all citations in this journal default. Or filter your current search. Similarly, the intervention group exhibited a 1-yr survival of Coincident with this finding, there has been increasing awareness that many peritoneal dialysis patients are volume wdemex, and that there are adverse cardiovascular consequences to this chronic overhydration.
This study provides evidence that increases in peritoneal small-solute clearances within the range stuvy have a neutral effect on patient survival, even when the groups are stratified according to a variety of factors age, diabetes mellitus, serum albumin levels, normalized protein equivalent of total nitrogen appearance, and anuria known to affect survival.
Gene Ontology GO Terms. There is also increasing evidence of the importance of residual renal function in maintaining euvolemia and as a prognostic indicator for survival.
The ADEMEX study and PD adequacy.