What is the recommended night dwell duration for patients initiating peritoneal dialysis (PD)?

Recommended Night Dwell Duration for Patients Initiating Peritoneal Dialysis

For patients initiating peritoneal dialysis, a night dwell duration of 9-10 hours is recommended based on body surface area (BSA), with 9 hours for patients with BSA <2.0 m² and 10 hours for patients with BSA >2.0 m². 1

Night Dwell Recommendations by Patient Size

The recommended night dwell duration varies according to patient size:

• BSA <1.7 m²: 9 hours with 2.5L volume 2, 1
• BSA 1.7-2.0 m²: 9 hours with 3.0L volume 2, 1
• BSA >2.0 m²: 10 hours with 3.0L volume 2, 1

Rationale for Night Dwell Duration

The night dwell serves several critical purposes in peritoneal dialysis:

1. Optimizes middle-molecule clearance: In patients with minimal residual kidney function (RKF), a continuous 24-hour PD prescription with appropriate night dwell maximizes middle-molecule clearance 2
2. Maximizes solute removal: Longer dwells allow for better clearance of uremic toxins 1
3. Improves volume control: Proper night dwell duration helps achieve adequate ultrafiltration 1

Modality-Specific Considerations

For CAPD (Continuous Ambulatory Peritoneal Dialysis)

• The overnight dwell is one of four daily exchanges
• Volume should be optimized based on BSA as noted above
• Supine position during night dwell allows for higher fill volumes due to lower intra-abdominal pressure 2

For APD (Automated Peritoneal Dialysis)

• Total night therapy should run for 9-10 hours based on BSA
• Multiple shorter cycles occur during this period
• Should include a daytime dwell to ensure 24-hour coverage 1

Special Considerations

1. Transport Characteristics: The peritoneal equilibration test (PET) should be performed approximately 1 month after PD initiation to assess membrane transport characteristics 2

   • Low transporters may require longer dwell times
   • High transporters may benefit from shorter dwells to prevent fluid reabsorption

2. Ultrafiltration Concerns: For patients with ultrafiltration failure, shorter dwell times may be necessary 3

   • Studies show that ultrafiltration with icodextrin does not significantly increase beyond 10 hours 4

3. Optimization Strategy: Consider varying dwell times and volumes within a session 5

   • Short dwells with smaller volumes favor ultrafiltration
   • Longer dwells with larger volumes favor solute removal

Common Pitfalls to Avoid

1. Ignoring transport characteristics: Failure to adjust dwell time based on PET results can lead to suboptimal clearance and ultrafiltration 1

2. Using full-volume exchanges immediately after catheter placement: This increases risk of leakage; begin with lower volumes 1

3. Neglecting middle-molecule clearance: In patients with minimal RKF, dry-day APD prescriptions may compromise middle-molecule clearance even if Kt/V targets are met 2

4. Overlooking patient comfort: Social factors and "burnout" are recognized causes of technique failure; prescriptions should balance medical requirements with quality of life 2

By following these guidelines for night dwell duration, clinicians can optimize the balance between adequate solute clearance and ultrafiltration while considering patient-specific factors that affect peritoneal dialysis outcomes.