DETERMINING PERITONEAL-DIALYSIS PRESCRIPTIONS BY EMPLOYING A PATIENT-SPECIFIC PROTOCOL

Objective: To develop a formula that would permit a rapid and simple c alculation of required dialysate volume needed to provide a predetermi ned daily creatinine clearance. Design: Prospective study of peritonea l dialysis patients followed for 6 months. Setting: A primary care tea ching hospital in New York. Patients: Twenty-six patients beginning pe ritoneal dialysis entered and completed the study. Intervention: By em ploying each patient's measured peritoneal equilibration test (PET) an d a standard clearance formula, a patient-specific treatment protocol (PSP) was calculated. The PET 2-hour D/P(creat) was used for continuou s cycling peritoneal dialysis (CCPD) and the 4 hour D/P(creat) was use d for patients on continuous ambulatory peritoneal dialysis (CAPD) to determine a PSP that would provide a minimum of 6 L of creatinine clea rance daily. Main Outcome Measures: Patients were followed for 6 month s to assess the ability of this approach of maintaining acceptable lev els of blood urea nitrogen, creatinine, albumin, and hematocrit over t he 6-month period of observation. Results: Our study of 26 patients re vealed that only 6 patients (23%) could be treated with the standard p rescription of 8 L/day on CAPD. The remaining 77% of our patients requ ired 9-13 L/day for CAPD and 12-21 L/day for CCPD. All patients were f ree of uremic symptoms and demonstrated acceptable biochemical paramet ers over a 3-6 month period of observation. Conclusions: A patient-spe cific protocol utilizing individually derived PET data provides an acc eptable and easy to calculate initial treatment prescription for each patient that avoids the necessity for trial and error that has heretof ore been employed.