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Designing dialysis prescriptions

A Manuel1, B Gray, N Coulis

  • 1Sunnybrook Health Science Centre, University of Toronto, Ontario, Canada.

Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis
|January 1, 1996
PubMed
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This study monitored home peritoneal dialysis patients to ensure adequate dialysis, achieving a target of total Kt/V greater than 2.0. Regular monitoring of peritoneal clearance and residual renal function helps maintain sufficient dialysis levels.

Area of Science:

  • Nephrology
  • Renal Replacement Therapy
  • Dialysis Adequacy

Background:

  • Home peritoneal dialysis is a common renal replacement therapy.
  • Ensuring adequate dialysis, defined as total Kt/V (tKt/V) > 2.0, is crucial for patient outcomes.
  • The CANUSA study provides guidelines for target dialysis adequacy.

Purpose of the Study:

  • To assess dialysis adequacy in home peritoneal dialysis patients.
  • To establish a surveillance program to maintain tKt/V > 2.0.
  • To analyze factors influencing dialysis adequacy, including patient weight and residual renal function.

Main Methods:

  • Eighty-nine patients undergoing home peritoneal dialysis were studied.
  • Initial dialysate volumes were patient-specific.

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  • Peritoneal equilibration tests were conducted post-discharge to determine tKt/V, with prescription adjustments made as needed.

    • Main Results:

    • Initially, 33.7% of patients had tKt/V < 2.0, while 66.3% had tKt/V > 2.0, largely influenced by residual renal function.
    • For continuous ambulatory peritoneal dialysis (CAPD), 34% had tKt/V < 2.0; for continuous cycling peritoneal dialysis (CCPD), 30.5% had tKt/V < 2.0.
    • Increased dialysate volume improved peritoneal Kt/V (dKt/V). Patients < 53 kg achieved adequate dKt/V without residual function, but higher weights depended more on it.

    Conclusions:

    • A surveillance program monitoring peritoneal clearance and residual renal function effectively maintains adequate dialysis (tKt/V > 2.0).
    • Dialysis prescription adjustments, particularly dialysate volume, can optimize adequacy.
    • Longer observation is needed to confirm if tKt/V > 2.0 ensures long-term patient health and well-being.