How to reach optimal creatinine clearances in automated peritoneal dialysis

Area of Science:

• Nephrology
• Renal Replacement Therapy
• Peritoneal Dialysis

Background:

• Automated peritoneal dialysis (APD) prescription guidelines are crucial for effective treatment.
• Peritoneal dialysis efficiency is influenced by factors like dialysate flow and patient-specific permeability.

Purpose of the Study:

• To summarize the basis for APD prescription established during a French national conference.
• To define and evaluate the concept of "maximal effective dialysate flow" (MEDF) for optimizing APD.

Main Methods:

• Analysis of clinical results and literature data on APD.
• Evaluation of peritoneal creatinine clearance in relation to hourly dialysate flow rate and peritoneal permeability.
• Definition and application of MEDF in nocturnal tidal peritoneal dialysis (TPD) and nightly intermittent peritoneal dialysis (NIPD) scenarios.

Main Results:

• Peritoneal creatinine clearance is primarily determined by peritoneal permeability and hourly dialysate flow rate.
• MEDF, the flow rate maximizing creatinine clearance, varies with peritoneal permeability and dialysis modality (TPD vs. NIPD).
• APD is not recommended for patients with a 4-hour creatinine dialysate-to-plasma ratio (D/P) below 0.50.

Conclusions:

• Optimizing APD prescription involves maximizing MEDF, considering individual patient peritoneal permeability.
• Tidal modalities can enhance MEDF, but session duration and patient needs (especially in anuric patients) may limit APD effectiveness.
• The MEDF concept provides a framework for tailoring APD prescriptions to achieve maximal peritoneal creatinine clearance.