Prescribing and peritoneal dialysis

Peritoneal dialysis is a home-based therapy for patients with end-stage kidney disease.It is less efficient in removing solutes and fluid than haemodialysis but offers more flexibility and independence.Peritoneal transport characteristics affect the dialysis prescription.The timing of drug administration is independent of the dialysis process except for the administration of intraperitoneal antibiotics.Dose reductions should follow current recommendations for patients with kidney disease.Fluid overload is common in patients undergoing peritoneal dialysis.Residual kidney function can ameliorate this problem and needs to be preserved.Dialysis solutions with high glucose concentrations contribute to adverse metabolic effects.Peritoneal dialysis-related catheter complications and infections may require patients to transition to haemodialysis.Antifungal prophylaxis needs to be co-administered for the duration of antibiotic courses for any indication to reduce the risk of fungal peritonitis.Close communication with the patient's supervising dialysis unit is required. Prescribing and peritoneal dialysisthe solution is left to dwell for several hours and then replaced with fresh dialysate.The peritoneal membrane allows movement of solutes and water between the vascular and peritoneal space.Its transport characteristics are assessed through an equilibration test and can be classified as low, lowaverage, high-average or high.8 Patients who are low transporters require longer dwell times, while high transporters usually need shorter dwells.Transport characteristics can change over time, and the process often fails eventually. DialysatesDialysis solutions generate the diffusion and osmotic gradients required for solute and water transport.Their glucose contents are high (1.5%, 2.5% and 4.25%) and contribute to hyperglycaemia, hyperinsulinaemia and dyslipidaemia.9 Solutions with higher glucose concentrations remove more fluid, but their use should be minimised.10 Glucose-sparing dialysates contain icodextrin, a starch-derived polymer.However, it is metabolised to maltose which is absorbed and causes falsely elevated blood glucose concentrations in monitors that are not specific for measuring glucose.11 More physiological dialysis solutions contain bicarbonate instead of lactate as a buffer.Their neutral pH can reduce inflow pain and preserve residual kidney function.1,3 Dialysates containing amino acids may be adjuncts in the treatment of malnutrition.12 However, higher costs limit their use.