Should the DOQI adequacy guidelines be used to standardize peritoneal dialysis in children?

The complete set of PD adequacy guidelines generated by NKF-DOQI is a valuable asset to the care of pediatric and adult patients receiving PD. Use of the recommendations generated by an evidence-based review of the literature (in addition to the expert opinion of the workgroup members who served as authors) has undoubtedly resulted in greater attention to detail in patient care and a more uniform approach to therapy. Whether the target clearances advocated for adults should serve as the standard for children is an issue where evidence is scant. Pertinent data needs to be generated by the pediatric nephrology community. Large pediatric study groups such as the North American Pediatric Renal Transplant Cooperative Study (NAPRTCS), the Pediatric Peritoneal Dialysis Study Consortium (PPDSC), and the Mid-European Pediatric Peritoneal Dialysis Study Group (MEPPS) need to collect information on dialysis clearance and a host of outcome variables such as hospitalization rate, technique survival, nutrition status, statural growth, neurodevelopment, quality of life, and patient mortality. The same groups should also encourage the development of prospective studies designed to further improve the dialysis care of children. Finally, it should be evident to all clinicians and emphasized in the DOQI guidelines that PD adequacy in children is defined by more than just solute and fluid control. Only when anemia, nutrition, infection, growth, and quality of life are optimally managed in combination with effective dialysis can a clinician feel confident that the child on PD has been provided with needed and deserved care.