Computation of the dose of continuous peritoneal dialysis required for adequate peritoneal urea clearance without taking into account peritoneal transport indices.
To test the feasibility of calculating, in the absence of peritoneal transport studies, the dose (daily drain volume) of continuous peritoneal dialysis (CPD) that will produce a high probability of adequate fractional peritoneal urea clearance (Kpt/Vurea), we randomly separated 619 clearance studies in patients on continuous ambulatory peritoneal dialysis (CAPD) with 4 daily exchanges into a derivation (n = 322) and a validation (n = 297) group. In the derivation group, the dialysate-to-plasma urea concentration ratio (D/Purea) was < or = 0.799 within the lowest 5% of the studies. By the urea clearance formula, a D/Purea value of 0.799 will produce weekly Kpt/Vurea values of 1.70 or better if the ratio of the daily drain volume to plasma water (Dv/V) is > or = 0.304 L/L. Among the 56 studies in the validation group with Dv/V values of 0.304 L/L or more, 52 (92.9%) had weekly Kpt/Vurea values of 1.70 or better. Assuming a suitable (low) D/Purea value for a given CPD treatment, it is possible to derive the dose of dialysis (the Dv/V ratio) that will provide adequate peritoneal urea clearance levels regardless of peritoneal transport characteristics. This method is applicable to the prescription of CPD for patients lacking studies of peritoneal transport. Anuric patients on CAPD with 4 daily exchanges require a Dv/V value of 0.304 L/L or better to have a > or = 0.9 probability of achieving a weekly Kpt/Vurea of 1.70 or better.
Tzamaloukas
Antonios H
AH
Medicine Service, New Mexico VA Health Care System, Albuquerque, New Mexico 87108, USA. Antonios.Tzamaloukas@med.va.gov
Onime
Aideloje
A
Raj
Dominic S C
DS
Murata
Glen H
GH
VanderJagt
Dorothy J
DJ
Servilla
Karen S
KS
D001692:Biological Transport; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D010537:Peritoneum / Q000378:metabolism*; D014508:Urea / Q000378:metabolism*
D014508:Urea