INTRODUCTION

Introduction

This PD Prescription Management Tool is based on currently available scientific evidence (as of 2015) and clinical practice guideline recommendations from professional societies. It is intended to be used only as a guide and not as a replacement for clinical judgment.

The original clinical practice tool (Peritoneal Dialysis Prescription Management Decision Tree, Baxter Healthcare Corporation, 1997) focused on the peritoneal dialysis prescription in terms of small solute removal to optimize clinical outcomes. These initial recommendations were based largely on observational data from the CANUSA study.¹ Two prospective randomized trials (one from Mexico, the other from Hong Kong), which evaluated the relationship between small solute clearance and clinical outcomes in patients on peritoneal dialysis, have since been published.^2-3 These studies represented a higher level of clinical evidence for use in formulating guidelines for adequacy of peritoneal dialysis. As a result, the National Kidney Foundation (NKF) of the United States (via a sponsored work group for adequacy of peritoneal dialysis) and other national work groups revised clinical practice guidelines. In general, data suggested that the minimal total solute clearance goal may be lowered and guidelines on preservation of residual kidney function (RKF) and maintenance of volume control be added.⁴ This tool has been designed to guide an individualized PD prescription that reflects national guidelines and data from recent prospective randomized clinical trials.

When prescribing peritoneal dialysis, one could empirically formulate a patient’s peritoneal dialysis prescription — obtain 24-hour collections of peritoneal dialysis effluent drain volume and urine volume — calculate the total solute removal (in terms of Kt/V_urea) — and adjust the prescription accordingly, a common approach in clinical practice. Alternatively, one could use prescription aids that would guide in formulating an individual patient’s prescription (instilled volume, dwell time and number of exchanges) by predicting what the solute removal would be based on certain parameters (patient’s weight, residual kidney clearance, volume of urea distribution (V_urea), etc.). These prescription management aids could be in the form of written material (such as this management tool) or computer-assisted programs. In both cases, these are meant to be used as a guide in prescription writing, not as a substitute for an actual determination of the patient’s delivered solute removal.

This prescription management tool is for informational purposes only and should not be considered medical advice. It contains sample PD prescriptions for average patients of various cohorts with specified ranges of V_urea, peritoneal transport type and residual kidney function. These prescriptions are for initial and subsequent therapy, are provided for informational purposes only and should not be substituted for individual clinical judgement. The clinical tool also includes recommendations for achieving and maintaining euvolemia as well as preservation of residual kidney function. Recommendations about monitoring adequacy of therapy are also reviewed. Included in the Appendix are typical formulas and information used in calculating small solute clearance, patient assessment, types of PD regimens and a summary of other guidelines.

This information is not intended to be the practice of medicine, nor does it replace medical clinical judgment. The information published in this document is for general and educational purposes only. This information is in no way meant to be a substitute for medical treatment and may not be construed as medical advice, diagnosis or treatment.

PD ADEQUEST software is a clinical tool that organizes dialysis therapy data to facilitate clinical decision making and patient care. It is in no way intended to be a substitute for clinical practice or a patient chart.

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