Dialysis adequacy targets in elderly chronic peritoneal dialysis patients

We performed the present study to determine dialysis adequacy targets for improved clinical outcome in elderly chronic peritoneal dialysis (PD) patients. Since 1993, 19 elderly patients (14 men, 5 women; 5 with diabetes, 14 without diabetes; mean age: 78.9 +/- 7.0 years; median time on PD: 47.7 months) at our center have been treated mainly with automated PD. Using the PD-NAVI software (JMS, Hiroshima, Japan), we measured the patients' peritoneal equilibration test (PET), Kt/V urea (Kt/V), creatinine clearance (CCr), and ultrafiltration (UF). The nutrition status of the patients was estimated by subjective global assessment (SGA), percentage creatinine generation rate (%CrGR), serum albumin, and ratio of extracellular fluid to total body water (ECF.TBW). For these patients, we particularly focused on reducing intra-abdominal pressure in the daytime. Despite lesser dwell volumes in the daytime, optimal prescriptions were reached by using the PD-NAVI simulation software to increase the nightly volume. All patients showed good SGA grades (A and B) with the modified prescriptions developed using PD-NAVI. Dialysis dose and nutrition parameters were as follows: dwell volume, 8.2 +/- 1.6 L/day; weekly Kt/V, 2.12 +/- 0.3; weekly CCr, 61.9 +/- 9.1 L; total UF, 891 +/- 157 mL/day; %CrGR, 119.1% +/- 18.4%; serum albumin, 3.5 +/- 0.3 g/dL; and ECF:TBW, 0.364 +/- 0.01. Overall patient survival was 82% at 135 months. Prescriptions for chronic PD that achieve adequate solute removal and sufficient UF, produce good clinical outcomes and good nutrition status in elderly patients.