RECOMMENDED CLINICAL PRACTICES FOR MAXIMIZING PERITONEAL-DIALYSIS CLEARANCES

Data from the Canada-U.S.A. (CANUSA) Study have recently confirmed a l ong-suspected linkage between total clearance and patient survival in peritoneal dialysis (PD). Recognizing that what we have historically a ccepted as adequate PD simply is not, the Ad Hoc Committee on Peritone al Dialysis Adequacy met in January, 1996. This committee of invited e xperts was convened by Baxter Healthcare Corporation to prepare a cons ensus statement that provides clinical recommendations for achieving c learance guidelines for peritoneal dialysis. Through an analysis of 80 6 PD patients, the group concluded that adequate clearance delivered w ith PD can be achieved in almost all patients if the prescription is i ndividualized according to the patient's body surface area, amount of residual renal function, and peritoneal membrane transport characteris tics. Use of 2.5 L to 3.0 L fill volumes, the addition of an extra exc hange, and giving automated peritoneal dialysis patients a ''wet'' day are all options to consider when increasing weekly creatinine clearan ce and KT/V. Rather than specify a single clearance or KT/V target, th e recommended clinical practice is to provide the most dialysis that c an be delivered to the individual patient, within the constraints of s ocial and clinical circumstances, quality of life, life-style, and cos t. The challenge to PD practitioners is to make prescription managemen t an integral part of everyday patient management. This includes asses sment of peritoneal membrane permeability, measurement of dialysis and residual renal clearance, and adjustment of the dialysis prescription when indicated.