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.
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Secondly, ADEMEX evaluated the effect of an increase in small solute, not middle molecular weight solute clearances on outcome.
The results suggest that over the range of solute clearance studied, increasing peritoneal solute clearance had no beneficial effect on survival. This study provides evidence that increases in peritoneal small-solute clearances within the range studied 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.
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.
How does Europe PMC derive its citations network? 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.
Read Article at publisher’s site. Similarly, the intervention group exhibited a 1-yr survival of The data confirms a that 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. Or filter your current search. 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.
The ADEMEX study and PD adequacy.
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. Comment in J Am Soc Nephrol. The ADEMEX study and subsequent investigations have changed the way we perceive the optimal peritoneal dialysis prescription.
As a result there has been a shift away from interest in peritoneal small solute clearance with renewed interest in peritoneal removal of salt ademwx water. Residual renal function did predict outcome.
The ADEMEX study and PD adequacy.
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.
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.
There is also increasing evidence of the importance of residual renal function in maintaining euvolemia and as a prognostic indicator for survival.
The primary endpoint was death. The minimal follow-up period was 2 yr. 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. Gene Ontology GO Terms. Find all citations in this journal default.
A total of subjects were randomly assigned to the intervention or control group in a 1: 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. 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.