Worldwide, dialysis adequacy has emerged as a key issue. It has been recognized that inadequate dialysis may result in the retention of uremic toxins, which can, among other things suppress appetite and result in malnutrition and morbidity. In January 1996, an Ad Hoc Committee on Peritoneal Dialysis Adequacy concluded that: 1) the dialysis prescription must be individualized; 2) by doing so, the suggested clearance guidelines can be achieved in almost all patients; 3) a wide range of regimens are available for individualizing the prescription; and 4) well-prescribed peritoneal dialysis (PD) is an excellent therapy for the majority of patients. According to the 1997 NKF-DOQI(TM) Clinical Practice Guidelines for Peritoneal Dialysis Adequacy, the delivered dose for CAPD should yield a total Kt/V(urea) of at least 2.0 per week, and a total creatinine clearance (C(cr)) of at least 60 L/week/1.73 m2. Many dialysis centers across the U.S. have implemented a continuous quality improvement (CQI) process to help improve dialysis adequacy. RenalWest Home Dialysis in Phoenix, AZ, improved their program's dialysis adequacy to the point where 80% of their patients met targeted adequacy markers within a 6-month period. Nebraska Health Systems/Clarkson Kidney Center in Omaha, NE, increased their understanding of PD adequacy by establishing a routine protocol for determining adequacy and by offering education on adequacy studies for all unit members. Satellite Dialysis Centers in Modesto, CA, discovered that 39% of their patient population had dropped out of PD. They implemented a CQI process to help patients achieve their adequacy targets and reduce PD dropout. As the recommendations of the Ad Hoc Committee gain widespread popularity, improving dialysis adequacy will become more achievable through the implementation of proven CQI processes.