CREATININE CLEARANCE AND UREA CLEARANCE IN PERITONEAL DIALYSIS: WHAT TO DO IN CASE OF DISCREPANCY

L ongitudinal studies have shown that morbidity and mortality are high in peritoneal dialysis (PD) when the dose of PD, measured either as fractional urea clearance (KtN) or creatinine clearance (CCr), is low (1-4). Consequently, minimal levels ofKt/V and CCr for "adequate " PD have been suggested. These minimal levels have increased over the years. Earlier, weekly standards were set at 1.7 for KtN and 50 L/l.73 m2 for CCr (5). Recent guidelines have set higher standards: 2.0 weekly for KtN and 60 L/l.73 m2 weekly for CCr in continuous ambulatory peritoneal dialysis (CAPD) (6,7); higher standards were suggested in continuous cycling peritoneal dialysis (CCPD) and in nightly intermittent peritoneal dialysis (NIPD) (7). The issue addressed in this editorial is what to do when one clearance index is above and the other below the "adequate " level