Does the peritoneal membrane transport status impact the prescribed dose of PD?
“Fast transporters” typically have no problem achieving adequate clearance of small solutes, given rapid equilibration of these substances across the peritoneal capillary membranes. Conversely, rapid absorption of glucose from the PD fluid and dissipation of the glucose-associated osmotic gradient occurs simultaneously, impacting adequate removal of both fluid and sodium. The latter is presumed to account for an increased risk of death and technique failure in “fast transport” patients treated with CAPD and longer dwell times. Modeling studies have suggested, and clinical studies have confirmed, that UF and sodium removal can be achieved in faster membrane transport through the prescription of shorter dwells (most conveniently done with APD) and icodextrin for the long dwell. Notably these prescriptive changes are also associated with significantly improved outcomes. An appropriate PD prescription, tailored to the patient’s peritoneal membrane transport, is imperative for optimal clinical outcome.