Is continuous ambulatory peritoneal dialysis adequate long-term therapy for end-stage renal disease? A critical assessment.

The significant growth in the continuous ambulatory peritoneal dialysis (CAPD) population and the recent interest in the quantitation of dialysis delivered have stimulated much work in the field of kinetic modeling, correlation between model parameters and clinical outcome, and comparison between the long-term benefits of hemodialysis and peritoneal dialysis. A critical assessment of the long-term results of CAPD therapy is made on the basis of clinical results and recent experience with kinetic models including urea and creatinine. The significant differences between the hemodialysis and CAPD techniques have generated hypotheses to allow comparison between the two groups using similar kinetic models. Although CAPD has proven beneficial in the initial treatment of large numbers of patients with ESRD, there is concern about the adequacy of CAPD as long-term therapy for many patients. Prospective, long-term studies applying solute kinetic modeling are necessary to establish the adequacy of CAPD.