Factors affecting peritoneal dialysis dose

Abstract

Dose of dialysis has traditionally been measured as small solute clearance (i.e. urea or creatinine). Treatment of acid-base, electrolyte, and volume disturbances should also be recognized as important functions of peritoneal dialysis (PD) that are not specifically measured when measuring urea clearance. There are a myriad of patient- and prescription-specific factors that affect the delivered dose of PD. Although patients with significant residual renal function (RRF) can likely initiate on virtually any standard PD therapy, with loss of RRF, one may need to tailor the PD prescription to the patient's membrane transport characteristics. High transporters as measured by the PET are better suited to automated peritoneal dialysis (APD) with more frequent exchanges, and the use of icodextrin as a long dwell, whereas patients with lower transport status will tend to do well on CAPD where exchanges are longer. Larger patients may tolerate increased volumes as a means of increasing the dose of PD. More frequent exchanges can be used in either CAPD or APD but one must recognize there is a limit due to loss of dialysate contact time from frequent filling and draining. Understanding the patient's physiological characteristics, personal preferences and social circumstances coupled with a sound comprehension of the principles of PD and the prescription-factors that affect dose will lead to the best care for that patient. © 2013 Springer-Verlag Berlin Heidelberg.