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. Read Article at publisher’s site. 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. Mortality rates for the two groups remained similar even after adjustment for factors known to be associated with survival for patients undergoing PD e. A prospective, randomized, controlled, clinical trial was performed to study the effects of increased peritoneal studg clearances on clinical outcomes among patients with end-stage renal disease who were being treated with PD.
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The ADEMEX study and PD adequacy.
Studg Opinion in Nephrology and Hypertension [01 Nov12 6: Gene Ontology GO Terms. Comment in J Am Soc Nephrol. How does Europe PMC derive its citations network?
The findings are clinically relevant, but there are some limitations of the study that may limit the generalizability of the results. 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. CitePeer Related Articles http: There is also increasing evidence of the importance of residual renal function in maintaining euvolemia and as a prognostic indicator for survival.
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. No clear survival advantage was obtained with increases in peritoneal small-solute clearances within the range achieved in this study.
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.
Or filter your current search. Overall, the control group exhibited a 1-yr survival of 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 avemex implication of this new ademes for the optimal peritoneal dialysis prescription. Similarly, the intervention group exhibited a 1-yr survival of Residual renal function did predict outcome.
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.
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. 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 primary endpoint was death. The results suggest that over the range of solute clearance studied, increasing peritoneal solute clearance had no beneficial effect on survival. The minimal follow-up period was 2 stuy. 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.
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. A total of ztudy were randomly assigned to the intervention or control group in a 1: 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.
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.