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.
|Published (Last):||2 December 2010|
|PDF File Size:||18.34 Mb|
|ePub File Size:||15.11 Mb|
|Price:||Free* [*Free Regsitration Required]|
Log in to view full text. If you're not a subscriber, you can:. Colleague's E-mail is Invalid. Your message has been successfully sent to your colleague. Save my selection.
Correspondence to Dr Joanne M. 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 prescription.
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. Coincident with this finding, there has been increasing awareness that many peritoneal dialysis patients are volume expanded, and that there are adverse cardiovascular consequences to this chronic overhydration.
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. 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 subsequent investigations have changed the way we perceive the optimal peritoneal dialysis prescription. 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.
You may be trying to access this site from a secured browser on the server. Please enable scripts and reload this page. Wolters Kluwer Health may email you for journal alerts and information, but is committed to maintaining your privacy and will not share your personal information without your express consent.
Send a copy to your email. Some error has occurred while processing your request. Please try after some time. Dialysis and transplantation. The implications of the ADEMEX study for the peritoneal dialysis prescription: the role of small solute clearance versus salt and water removal.
Current Opinion in Nephrology and Hypertension12 6 , November Add Item s to:. An Existing Folder. A New Folder. The item s has been successfully added to " ". Thanks for registering! Be sure to verify your new user account in the next 24 hours, by checking your email and clicking the "verify" link. This article has been saved into your User Account, in the Favorites area, under the new folder " ".
End Note. Reference Manager.
Register for a free account
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. A total of subjects were randomly assigned to the intervention or control group in a ratio. 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. The primary endpoint was death. The minimal follow-up period was 2 yr.
The ADEMEX Study and PD Adequacy