ENHANCEMENT OF PERITONEAL-DIALYSIS - THE PD PLUS CONCEPT

The need for a peritoneal dialysis modality capable of providing highe r clearances of small solutes at a competitive cost with continuous am bulatory peritoneal dialysis (CAPD) has been identified. A new modalit y of therapy (PD Plus; Fresenius USA, Walnut Creek, CA), which is base d on the principles of optimal dwell time and large exchange volumes w hile the patient is supine, is described. This technique combines auto mated cycles with a manual diurnal exchange. Seven patients were studi ed during CAPD and while on PD Plus, Peritoneal Kt/V-urea increased fr om 0.22 +/- 0.04 to 0.29 +/- 0.07 (P < 0.002), creatinine clearance fr om 37.69 +/- 2.45 to 51.14 +/- 8.34 L/ wk/1.73 m(2) (P < 0.005), and n ormalized protein catabolic rate from 0.74 +/- 0.14 to 0.80 +/- 0.15 g /kg/d during CAPD and PD Plus, respectively, with a mean increase in d ialysis solution volume of only 2.76 L. A comparative cost-efficiency analysis demonstrated a highly significant increase in dialysis dose ( Delta Kt/V-urea 57%) for a small increase in cost (6%) between CAPD an d PD Plus, The data suggest that a significant increase in dialysis do se is possible with a minimal increase in the cost of therapy. (C) 199 6 by the National Kidney Foundation, Inc.