From the Guidelines
The minimal "delivered" dose of total small-solute clearance for peritoneal dialysis should be a peritoneal Kt/V urea of at least 1.7 per week. This dose should be measured within the first month after starting dialysis therapy and at least once every 4 months thereafter 1.
Key Considerations
- The dose of peritoneal dialysis is crucial for removing uremic toxins and maintaining fluid balance.
- The peritoneal Kt/V urea is a measure of the dialysis dose, with a higher value indicating more effective removal of waste products.
- Regular monitoring of clearance parameters, including Kt/V and creatinine clearance, is necessary to determine if the effluent dose is appropriate.
Factors Affecting Dose
- Residual kidney function: patients with residual kidney function may require a lower dialysis dose.
- Ultrafiltration needs: patients with high fluid intake or those who are prone to volume overload may require a higher dialysis dose.
- Peritoneal membrane characteristics: the peritoneal membrane's ability to transport waste products can affect the required dialysis dose.
Clinical Implications
- Underdosing may lead to inadequate clearance and uremic symptoms, while overdosing can cause discomfort, leakage, or hernias.
- Individualization of the dialysis dose is essential to ensure optimal outcomes and minimize complications.
- The dose should be adjusted based on regular monitoring of clearance parameters and the patient's clinical status 1.
From the Research
Effluent Dose in Peritoneal Dialysis
The effluent dose in peritoneal dialysis refers to the amount of waste products removed from the body through the dialysate.
- The effluent dose is typically measured in terms of the volume of ultrafiltrate (fluid removed from the body) per unit of body weight per hour 2.
- A minimum adequate effluent dose is considered to be 20 mL/kg/h for 85% of the time on continuous renal replacement therapy (CRRT) 2.
- The equivalent renal urea clearance (EKRjc) is a measure that takes into account both residual renal function and dialytic urea clearance, and can be used to estimate the effluent dose 2.
- The EKRjc can be calculated using the formula EKRjc = 10 Kt/V + 1, where Kt/V is a measure of dialysis adequacy 2.
- In patients undergoing combination therapy with peritoneal dialysis and hemodialysis, the total weekly dialysis dose (urea) can be calculated by adding the dialysis dose by hemodialysis to the dialysis dose by peritoneal dialysis 3.
Factors Affecting Effluent Dose
- The effluent dose can be affected by various factors, including the type of dialysate used, the frequency and duration of dialysis sessions, and the patient's residual renal function 2, 3, 4.
- Increasing the blood flow rate during hemodialysis can also increase the effluent dose 5.
- The use of combination therapy with peritoneal dialysis and hemodialysis can help to increase the effluent dose and improve dialysis adequacy in patients with insufficient dialysis dose 3, 4.