CAREFUL PATIENT SELECTION AND DIALYSIS PRESCRIPTION ARE REQUIRED FOR EFFECTIVE NIGHTLY INTERMITTENT PERITONEAL-DIALYSIS

Objective: To evaluate the adequacy of dialysis in patients on nightti me intermittent peritoneal dialysis (NIPD). Design: Retrospective revi ew of prospectively collected data. Patients: Seven patients on NIPD. Measurements: The fast peritoneal equilibration test (PET) was used to determine peritoneal membrane permeability for small solutes. Adequac y of dialysis measured by 24-hour collections of dialysate and urine f or weekly KT/V and creatinine clearance in liters/week/1.73 m2 was ass essed in patients with (n=3) and without (n=4) residual renal function and evaluated in concert with the patient's clinical status. Outcome for each patient was also noted. Results: Five of the patients had a h igh-average dialysate/serum creatinine by PET(>0.66). Despite a weekly KT/V of 1.7 or more, four of the seven patients on NIPD were uremic a nd either transferred to hemodialysis or continuous cycling peritoneal dialysis (CCPD). A fifth patient had a KT/V of 1.4 and was also uremi c on NIPD.The patient who was clinically well and continued on NIPD ha d significant residual renal function. Conclusions: NIPD should be res tricted to patients with high-average dialysate/serum creatinine as de termined by PET and residual renal function or those with high dialysa te/serum creatinine. Extended dialysis time and large volumes of dialy sate are required for successful NIPD in patients without residual ren al function. Accepted parameters of dialysis adequacy used for patient s on continuous peritoneal dialysis are not appropriate for intermitte nt forms of peritoneal dialysis.