Continuous adaptation of the dialysis prescription maintains adequate Kprt/V in CAPD patients

Objective: To analyze the effect of individual adaptation of the dialysis p rescription in continuous ambulatory peritoneal dialysis (CAPD), as compens ation for the decline of residual renal function (RRF), on peritoneal (Kpt/ V) and total (Kprt/V) urea clearance as well as on peritoneal (Kpcr) and to tal weekly creatinine clearances (CCr). Design: Retrospective analysis of a 5-year period. Patients: We analyzed 18 patients [15 male, 3 female; mean age 58.2 (24 - 8 0) years]. Main Outcome Measures: Correlations between increased dialysis prescription and Kpt/V, Kprt/V, and Kpcr. Kpr/V and CCr measurements were based on a 24 -hour dialysate and urine collection. Measurements were performed over a ti me period of 3 to 6 months. Results: The results show a linear correlation between Kpt/V and Kpcr and t he prescribed volume by kilogram body weight. Kprt/V was increased slightly by increasing the dialysis prescription. Dialysate-to-plasma (D/P) ratios of urea and creatinine remained unchanged. The mean prescribed dialysate vo lume increased from 7.4 +/- 1.1 L to 10.6 +/- 2.5 L. Mean Kprt/V could be m aintained on a stable level for a 36-month period. Conclusion: By adapting the dialysis prescription on an individual basis to the continuous decline of RRF, and taking the patient's body weight into a ccount in the prescription decision, the increases in Kpt/V offset the decl ine in RRF. We recommend early individualization of prescription for patien ts on CAPD.