Bridging the Quantum gap: attaining adequacy utilizing the Quantum night-time exchange device

The advent of night-time exchange devices (NXDs), such as the Quantum, gives the client on home peritoneal dialysis the option of five exchanges well spaced in a day or, for those who need only four exchanges a day, the ability to change their long dwell to the daytime.

To ascertain whether we were able to attain the NKF-DOQI recommended Kt/V of 2.0 for CAPD clients by adding a fifth exchange utilizing the Quantum NXD or by introducing a long daytime dwell for clients who only needed four exchanges per day. We also looked at alternative uses for a NXD.

As part of our CQI process for all clients on home peritoneal dialysis, dialysis adequacy testing is performed two weeks after the start of full prescription and biannually thereafter. In this study, the first group of clients, the "lifestyle group", changed to using the NXD to allow more daytime freedom. This first group had repeated 24 hour dialysate collections to ensure they maintained adequate Kt/Vs. The second group of clients, the "adequacy group", had Kt/Vs falling below the NKF-DOQI recommendation of 2.0. This second group had their peritoneal dialysis prescription optimized utilizing a computer modeling program. Their prescription was then changed accordingly Two weeks after the change in prescription, 24 hour dialysate collections were repeated for each client to ensure the new Kt/Vs were within the predicted parameters.

We were able to attain the NKF-DOQI recommended Kt/V, utilizing the CANUSA recommended fill volumes, for all clients underdialyzed on CAPD through the addition of a fifth exchange using the NXD. Other clients who may benefit from the use of NXDs are those who need more daytime freedom.