Tailoring the Peritoneal Dialysis Prescription

M. D., a 62‐year‐old female with renal disease secondary to bilateral polycystic kidneys and hypertension, opted for continuous ambulatory peritoneal diaiysis (CAPD) when her renal function deteriorated (24‐hr urinary creatinine clearance of 6.8 ml/ min in a total urinary volume of 1200 ml) and uremic symptoms developed. The patient lived about a 3‐hr drive from the nearest dialysis center. This factor weighed heavily in the patient's decision to choose home dialysis . A Swan Neck Missouri peritoneal dialysis catheter was inserted by a surgeon under local anesthesia with no complications. Since the patient was symptomatic from the uremia, peritoneal dialysis using a cycler in the supine position was initiated about 18 hr after the catheter insertion. To avoid dialysis solution leak from the incision site, 1 1 volumes per exchange and a 0.5‐hr cycle time were chosen. The cycler dialysis continued for 36 hr. The amount of ultrafiltration achieved was 2200 ml. The patient received two additional treatments using cycler dialysis during the next seven days before CAPD training was begun. CAPD training was accomplished in five working days. A baseline peritoneal equilibration test (PET) was carried out and thr residual renal function was determined. Based on the D/P creatinine ratio and the glucose results of the PET, the patient was classified as having a high peritoneal membrane transport rate. The renal creatinine and urea clearances were 5.7 and 4.2 ml/min, respectively (24‐hr urine volume was 926 ml ).