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Applications in Kinetic Modeling Using Pd Adequest®

R studies investigating the relationship between dose of dialysis and patient outcome have shown that increases in total solute clearance are associated with significant improvement in patient outcome (1-9). As a result, it has been recommended that patients receiving some form of continuous peritoneal dialysis (PD) achieve a minimum weekly urea KT/V of 2 and/or a weekly total creatinine clearance (Ccr) of 60 L/week/1.73m (10-11). Based on these recommendations, there has been renewed interest in PD prescription modeling as a means for evaluating whether individual patients can achieve these targets, particularly as the patient loses his or her residual renal function (12). Currently, there are several kinetic modeling software programs available which clinicians may use to tailor PD prescriptions to the needs of the individual patient (13-19). These include the PD ADEQUEST® (Baxter Healthcare Corporation, Deerfield, IL), PACK PD (Fresenius USA, Walnut Creek, CA) and PDCTM (Gambro AB, Lund, Sweden) programs. In this paper, we briefly discuss and review the theoretical basis for individualized kinetic modeling as it is implemented in thePD ADEQUEST® software program. The strengths and limitations of the model are discussed, as are examples of how PD ADEQUEST® might be used clinically to evaluate patient noncompliance and/or suitability for PD.