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The effects of increasing exchange volume and frequency on peritoneal dialysis adequacy
1Department of Medicine, The George Washington University Medical Center, Washington, DC 20037, USA.
Aim:
Peritoneal dialysis adequacy guidelines are generally not met with the standard prescription of continuous ambulatory peritoneal dialysis (CAPD), four 2-liter (1) exchanges daily. The aim of this study is to determine the effects of increasing exchange volume singularly or in combination with frequency on peritoneal dialysis adequacy.
Patients And Methods:
Fourteen stable ESRD patients receiving peritoneal dialysis were evaluated for adequacy and nutritional status between the fourth and sixth months during a six-month baseline period in which the dialysis prescription was four two-liter exchanges daily and during a six-month intervention period in which patients (n = 7) from group 1 were prescribed CAPD four 2.5-liter exchanges daily while patients (n = 7) from group 2 were prescribed continuous cycling peritoneal dialysis (CCPD - 12 l) using four 2.5 liters during the night and a 2-liter wet day.
Results:
Mean total weekly urea Kt/V (TWKt/V) increased significantly from 1.6 +/- 0.2 to 2.1 +/- 0.2, p <0.01 in group 1, and from 1.6 +/- 0.4 to 2.1 +/- 0.5, p <0.001 in group 2. Mean normal total weekly creatinine clearance increased significantly from 51 +/- 11 to 60 +/- 8 l/1.73 m2, p <0.05 in group 1, and from 45 +/- 6 to 58 +/- 9 l/1.73 m2, p <0.01 in group 2. Serum albumin of almost all patients in the intervention groups were higher than in the baseline groups. Mean serum albumin increased from 3.6 +/- 0.4 to 4.0 +/- 0.4 g/dl, p <0.01 in group 1, and from 3.8 +/- 0.2 to 4.0 +/- 0.4, p <0.05 in group 2. The magnitude of the decrement in BUN and serum creatinine were greater in group 2 than group 1 (p <0.001 and p <0.05, respectively). When the two intervention groups were compared to each other, no significant differences in the delivered dialysis dose or nutritional status were noted.
Conclusion:
In conclusion, it is possible to achieve currently proposed adequacy target by increasing the exchange volume singularly or in combination with frequency in most peritoneal dialysis patients.