Beyond CANUSA, DOQI, ADEMEX: What's next?

Abstract

In summary, there is growing evidence suggesting that PD patients are fluid overloaded. Fluid overload in PD is unavoidable when RRF begins to decline if measures to increase peritoneal ultrafiltration or to decrease fluid intake are not implemented; fluid overload may have contributed significantly to the still unacceptably low technique survival of PD. This issue is, however, not emphasized in the CANUSA and ADEMEX studies, nor in the DOQI guidelines. It has to be addressed in future studies. Improving compliance to diet as well as to dialysis exchange prescriptions and exploring new PD solutions or regimens that could improve peritoneal fluid removal are important areas that will, we hope, lead to improved outcomes of PD therapy.