From the Guidelines
For a fast to average transporter, I recommend a peritoneal dialysis prescription that includes 2.0 to 2.5 L exchanges per day for Continuous Ambulatory Peritoneal Dialysis (CAPD) or 2.0 to 2.5 L (9 hours/night) with 2.0 L/day for Continuous Cycling Peritoneal Dialysis (CCPD), based on the patient's body surface area (BSA) and residual kidney function (RKF) 1.
Key Considerations
- The initial dialysis prescription can be empirically based on the patient's weight, amount of residual kidney function, and lifestyle constraints, with adjustments made after peritoneal equilibration testing 1.
- For patients with an estimated underlying GFR < 2 mL/min, the prescription may include:
- CAPD: 2.0 L exchanges/day for BSA 1.7 m2, 2.5 L exchanges/day for BSA 1.7 to 2.0 m2, and 3.0 L exchanges/day for BSA 2.0 m2 1.
- CCPD: 2.0 L (9 hours/night) with 2.0 L/day for BSA 1.7 m2, 2.5 L (9 hours/night) with 2.0 L/day for BSA 1.7 to 2.0 m2, and 3.0 L (9 hours/night) with 3.0 L/day for BSA 2.0 m2 1.
- For patients with an estimated underlying GFR ≥ 2 mL/min, the prescription may include:
- CAPD: 2.5 L/day for BSA 1.7 m2, 3.0 L/day for BSA 1.7 to 2.0 m2, and 3.0 L/day with consideration of a simplified nocturnal exchange device for BSA 2.0 m2 1.
- CCPD: 2.5 L (9 hours/night) with 2.0 L/day for BSA 1.7 m2, 3.0 L (9 hours/night) with 2.5 L/day for BSA 1.7 to 2.0 m2, and 3.0 L (10 hours/night) with 3.0 L/day for BSA 2.0 m2 1.
Monitoring and Adjustments
- Regular monitoring of ultrafiltration volumes, residual kidney function, and clearance measurements (Kt/V and creatinine clearance) is essential, with prescription adjustments every 1-3 months based on these parameters and the patient's clinical status 1.
From the Research
Peritoneal Dialysis Prescription for Fast to Average Transporters
- The use of icodextrin, a high molecular weight glucose polymer, has been shown to be effective in promoting sustained ultrafiltration in peritoneal dialysis patients, particularly those with high or high-average transporter status 2, 3.
- Icodextrin can be used as a substitute for glucose-based dialysates in the long-dwell exchange, providing improved fluid balance and reduced carbohydrate load 2.
- Studies have demonstrated that icodextrin increases peritoneal clearances of creatinine and urea nitrogen compared to glucose-based solutions 2.
- The use of icodextrin in automated peritoneal dialysis (APD) has been shown to allow sustained ultrafiltration while reducing the peritoneal glucose load 4.
- Fast transporters, who have a rapid peritoneal solute transport rate, may benefit from the use of icodextrin-based PD solutions, particularly when used in conjunction with APD 5.
Key Considerations
- Icodextrin is generally well-tolerated, with a similar tolerability profile to glucose-based solutions, although there is a slightly increased risk of skin rash 2.
- The use of icodextrin may require adjustments to the dialysis prescription, including the volume and frequency of exchanges 2, 4.
- Further studies are needed to confirm the long-term benefits and safety of icodextrin use in peritoneal dialysis patients 2, 3.