Implications of the Canada-USA (CANUSA) study of the adequacy of dialysis on peritoneal dialysis schedule.

data suggest that dialysis treatment should be initiated The CANUSA study group included 14 centres in earlier, that the total weekly clearance of small molecuNorth America; 10 in Canada and four in the US. lar weight solutes should be considerably higher than There were 680 new CAPD or continuous cyclic periis current practice and that higher peritoneal transport toneal dialysis (CCPD) patients enrolled between is not a desirable feature for CAPD treatment. These September 1, 1990 and December 31, 1992 with followsuggestions are controversial [5,6 ]. There are concerns, up recorded until December 31, 1993. in an incident dialysis population, about the relative Adequacy of dialysis was estimated by measurement value of clearance due to residual renal function and of total weekly Kt/V for urea and total weekly creatinthat due to peritoneal dialysis. Others are concerned ine clearance (CCr). Daily peritoneal Kt was estimated that earlier initiation of dialysis may not be accepted from a 24 h dialysate urea excretion and the serum by funding agencies and that the increased economic urea concentration at the conclusion of the collection burden is not justifiable. Higher adequacy targets are period. Renal Kt was estimated from the concurrent not considered feasible for heavier patients with little 24 h urine urea excretion. Total body water was estimresidual function, and the increased cost of higher ated from the formula of Watson et al. [7]. Peritoneal dialysate volumes may discourage some providers. CCr was estimated from a 24 h dialysate excretion and The objective of this review is to present the concluthe serum creatinine concentration at the end of the sions reached in the peer-reviewed publications from collection period. Dialysate creatinine concentration the CANUSA peritoneal dialysis study group [1,2,4] was corrected for glucose interference using a valiand to consider the controversy regarding the clinical dated technique-specific correction factor. The renal inferences derived from those conclusions. contribution was an estimate of glomerular filtration