DIFFICULT MANAGEMENT PROBLEMS IN DIALYSIS .2. TAILORING THE PERITONEAL-DIALYSIS PRESCRIPTION

M. D., a 62-year-old female with renal disease secondary to bilateral polycystic kidneys and hypertension, opted for continuous ambulatory p eritoneal dialysis (CAPD) when her renal function deteriorated (24-hr urinary creatinine clearance of 6.8 m/l min in a total urinary volume of 1200 ml) and uremic symptoms developed. The patient lived about a 3 -hr drive from the nearest dialysis center. This factor weighed heavil y in the patient's decision to choose home dialysis. A Swan Neck Misso uri peritoneal dialysis catheter was inserted by a surgeon under local anesthesia with no complications. Since the patient was symptomatic f rom the uremia, peritoneal dialysis using a cycler in the supine posit ion was initiated about 18 hr after the catheter insertion. To avoid d ialysis solution leak from the incision site, 1 l volumes per exchange and a 0.5-hr cycle time were chosen. The cycler dialysis continued fo r 36 hr. The amount of ultrafiltration achieved was 2200 ml. The patie nt received two additional treatments using cycler dialysis during the next seven days before CAPD training was begun. CAPD training was acc omplished in five working days. A baseline peritoneal equilibration te st (PET) was carried out and the residual renal function was determine d. Based on the D/P creatinine ratio and the glucose results of the PE T, the patient was classified as having a high peritoneal membrane tra nsport rate. The renal creatinine and urea clearances were 5.7 and 4.2 ml/min, respectively (24-hr urine volume was 926 ml).