Prediction of Dialysate Volume to Achieve the Adequacy Target of Small Solute Clearance in Chronic Peritoneal Dialysis Patients
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Abstract
Background: Adequacy of peritoneal dialysis (PD) depends partly on small solute clearance which is the product of daily total dialysate volume (dTV) and D/P of that solute. DTV depends largely on the body size. Studies on the prescription of PD to achieve adequacy in small solute clearance are limited. The present study aimed to find simplified equations that could predict individual dTV required to achieve the targets of small solute clearance in patients receiving continuous ambulatory PD (CAPD) and nocturnal intermittent PD (NIPD).
Methods: We retrospectively analyzed 246 CAPD patients and 100 NIPD patients using the results of peritoneal equilibration test (PET), and residual renal function. The average dialysate/plasma urea (D/P urea), dialysate/plasma creatinine (D/Pcr) and urine/plasma urea (U/P urea) were used to calculate dTV to achieve small solute clearance target of weekly total KT/V urea ≥1.7 and normalized creatinine clearance (nCCr) ≥45 L/week/body surface area (BSA) of 1.73 m2.
Results: The average D/P urea and D/Pcr in CAPD patients were 0.94 ± 0.10 and 0.73±0.10, respectively. The median U/P urea among non-users of furosemide was 4.2. The median U/P urea for users of <250 mg of furosemide daily and ≥250 mg daily were 3.76 and 2.93, respectively. To achieve the target KT/V, the predicted dTV was 0.26 x total body water (TBW) – 3 x urine volume (UV) for those using furosemide ≥250 mg daily and 0.26 x TBW – 4 x UV for those using furosemide <250 mg daily. To achieve the nCCr target, the predicted dTV was 5 x BSA – 2 x GFR (ml/min). In NIPD, the average D/P urea was 0.68 ± 0.12 and the median U/P urea for furosemide users and non-users were 3.35 and 4.2, respectively. To achieve the target KT/V ≥1.7, the predicted dTV was 0.36 x TBW – 5 x UV and 0.36 x TBW – 6 x UV for furosemide users and non-users, respectively. The predicted dTV to achieve the nCCr goal depended on the category of PET and residual renal function.
Conclusions: The adequate dTV in CAPD patients was one-fourth of TBW. APD patients required 40% higher dTV than CAPD patients. Residual renal function significantly reduced dTV.
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