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Classification of CAPD Delivery: Measured vs. Actual Kt/V

Urea kinetic modeling in hemodialysis differs from that in peritoneal dialysis in a number of ways. The most important difference is that inaccuracies in estimating V (body water or the urea distribution volume) impact little on Kt/V in hemodialysis (due to proportional errors in K) but have a potentially large impact (proportional to the error in V) on Kt/V in peritoneal dialysis (1). Substantial errors in estimating V in peritoneal dialysis patients have been well documented indicating that equally substantial differences between actual (a) Kt/V and measured (m) Kt/V are expected (2). Accordingly, it is valuable to recognize that patients can theoretically be classified according to the relationship between their measured and actual (but usually unknown) Kt/V. The primary value of this largely intellectual exercise is to facilitate clinical recognition of patients who may be achieving target levels of Kt/V but who are still underdialyzed (a Kt/V value of 2.1 per week has been used for this target in the figure).