Elements of a Peritoneal Dialysis
What are the elements of a Peritoneal Dialysis prescription and how is it determined?
Elements of a PD prescription include:
- • Total number of exchanges per day
- • Dwell duration, dwell volume, and PD fluid content (dextrose, icodextrin, amino acid) of each exchange
- • The method of PD (CAPD or by cycler [APD], and whether the peritoneum is dry for any part of the day, is also included in the prescription.
The PD prescription is individualized for each patient based on his or her physiologic needs and desired lifestyle. The former is determined by the size of the patient (either volume of distribution of urea or body surface area), their peritoneal membrane transport characteristics, and their RKF. Further adjustment can be made based on dietary and fluid intake of the patient. The prescription can then be modified to accommodate their work, school, or social schedule using either CAPD or APD. In general, patients with fast peritoneal membrane transport require shorter dwell times (as equilibration happens quickly), whereas those with slower membrane transport require longer dwell times. Although minor differences are apparent, icodextrin is handled similarly, irrespective of membrane transport type.