Long-term successful nocturnal intermittent peritoneal dialysis: a ten-year case study

We report a case of polycystic kidney disease, successfully dialyzed using nocturnal intermittent peritoneal dialysis (NIPD) for ten years. Other forms of renal replacement therapy, which included hemodialysis, continuous ambulatory peritoneal dialysis (CAPD), intermittent peritoneal dialysis (IPD), and renal transplantation, were unsuitable for the patient. A peritoneal equilibration test revealed a 4-h D/P creatinine (Cr) ratio of 0.54. In January 1984, the patient began NIPD for 12 h, using a dialysis solution dose of 14 L/day, and 2 L/exchange. In January 1986, because of clinical under-dialysis, the dialysis solution dose was increased to 20 L/day, with an exchange volume of 1.57 L. The prescribed outflow time was 20 min. Dialysis was still inadequate with a weekly corrected Cr clearance (CoCrCl/w) of 33.6 L. In August 1986, the outflow time was reduced to 14 min and the total dialysis time to 11 h. Despite the latter, the efficiency of dialysis was greater because of longer full contact between dialysate and peritoneum. The last change resulted in marked clinical improvement and CoCrCl/w increased to 39.9 L. Over the years, the patient's peritoneal transport changed to high average (4-h D/P Cr = 0.74) and NIPD provided even better clearances (CoCrCl/w = 59.96 L in 1994). The report emphasizes that NIPD, if properly tailored, can provide clinically adequate long-term dialysis.