Adequacy targets in peritoneal dialysis.

Adequate solute and fluid removal are the cornerstones of dialysis treatment. In peritoneal dialysis, what constitutes adequate removal, has been hitherto controversial, based as it was on DOQI guidelines. There are now 2 randomised controlled trials that address solute removal--both indicate that the minimal Kt/V needs to be 1.7. This needs to be adjusted in individual cases based on clinical and other parameters. Fluid removal and blood pressure control are also important adequacy parameters. Sub-clinical fluid overload is a common feature and relates to left ventricular hypertrophy. This also needs addressing but estimating fluid status is difficult.