Comparison between DOQI and Canadian Guidelines for Peritoneal Dialysis

The recently published Canadian Society of Nephrology (CSN) Guidelines for Peritoneal Dialysis Adequacy differ in a number of ways from the United States National Kidney Foundation Dialysis Outcomes Quality Initiative (DOQI) guidelines on the same topic. The three main differences are ( 1 ) the CSN targets are the same for continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD), whereas the DOQI targets are higher for APD; ( 2 ) the CSN guidelines have a lower creatinine clearance (CCr) target of 50 L/wk for low and low-average transporters compared to 60 L/wk for high and high-average transporters, but no such distinction is made by DOQI; and ( 3 ) the CSN has set lower limit targets as well as preferred targets for Kt/V and CCr. Other differences are that the CSN recommendations do not give Kt/V the same primacy over CCr that DOQI does. Also, the CSN recommendations give greater emphasis to the risks associated with high transport status. This review looks at the reasons for these differences and demonstrates that some are due to information that has become available since the publication of the DOQI guidelines. However, it is emphasized that, when recommendations are predominantly opinion- rather than evidence-based, geographic and economic factors may also account for differences.