ABSTRACT
The definition of adequacy of a dialytic treatment has a broad scope including control of biochemical and outcome parameters such as azotemia, acid-base indices, serum electrolytes, body fluid balance, nutrition, rehabilitation, and quality and length of life (1-3). Unlike hemodialysis (HD) or intermittent forms of peritoneal dialysis (PD), the pattern of serum electrolyte concentration is usually within the normal limits in most patients on continuous forms of PD. Electrolyte abnormalities (e.g., hypokalemia) in continuous PD are often the result of conditions extrinsic to the process of dialysis (e.g., gastrointestinal losses), although they can occasionally reflect nutritional status. Quality and length of life issues are primarily determined by comorbidities. For example, diabetic patients have the poorest quality of life and the shortest survival of all dialysis patients. For these reasons, adequacy of PD has been limited in many discussions to adequacy of salt and water control, adequacy of control of azotemia, and prevention of worsening uremia (4). The NKF-DOQI PD Adequacy Work Group, which both authors served on, struggled with these limitations because guideline development requires firm data. Therefore, this chapter will focus on complications of PD that relate to inadequate delivered dose of dialysis, focusing on the consequences of poor azotemic control, its recognition, and
management. Fluid balance and its ramifications in PD patients will be discussed in the context of their interface with the control of azotemia and as they relate to cardiovascular comorbidities.
