Dialysis adequacy indices in high membrane transporters treated with short-dwell peritoneal dialysis

Treatment of high-membrane transporters with continuous ambulatory peritoneal dialysis (CAPD) is associated with ineffective ultrafiltration, increased dialysate protein loss, lower serum albumin levels, and lower protein catabolic rates, suggesting development of inadequate dialysis. The use of short-dwell nightly intermittent peritoneal dialysis (NIPD) and daytime ambulatory peritoneal dialysis (DAPD) has not been evaluated. Patients with inadequate ultrafiltration secondary to rapid membrane transport [peritoneal equilibration test (PET) confirmation] were managed with NIPD and DAPD (group A, n = 32) and compared to patients on CAPD and continuous cycling peritoneal dialysis (CCPD) (group B, n = 53) after at least 3 months of therapy. Groups A and B were similar in age, gender, diabetic status, prestudy months on peritoneal dialysis (PD), and residual renal function. No significant differences were observed between the groups with respect to serum albumin, daily protein loss, normalized protein catabolic rate (PCRN), or weekly KT/V urea indices. Diabetics demonstrated lower levels of serum albumin and PCRN than nondiabetics while maintaining equivalent KT/V urea indices. Reassessment of patients 6 months later also revealed no differences in outcome measures between group A (n = 20) and group B (n = 36). High transporters treated with NIPD and DAPD appear to have similar dialysate protein loss, adequacy, and nutrition indices when compared to patients on CAPD and CCPD. Future studies will determine if delivery of higher target small-solute clearances benefits patients on NIPD/DAPD as contrasted with continuous PD modalities (CAPD/CCPD), or diabetics compared to nondiabetics.