How would you approach a patient with end stage kidney disease on peritoneal dialysis who has an adequate Kt/V but persistent azotemia?

This question could serve as the springboard for a very lengthy discussion/ debate regarding PD "adequacy"- a term that ought to be outlawed! That said, I will try to be brief.

First off, it must be recognized that Kt/V (by default meaning that for urea) is a very poor measure of the quality of dial...