Peritoneal Dialysis Prescription
Peritoneal dialysis (PD) has a variety of advantages over hemodialysis (HD), such as autonomy and flexibility. If an individual patient on PD has a deep understanding and sufficient experience of PD, PD prescription can be modified by his or her own will
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Mi Jung Lee and Dong-Ryeol Ryu
Peritoneal dialysis (PD) has a variety of advantages over hemodialysis (HD), such as autonomy and flexibility. If an individual patient on PD has a deep understanding and sufficient experience of PD, PD prescription can be modified by his or her own will and purpose on a daily basis. However, many PD patients have trouble with adapting themselves to changing their residual renal function (RRF) and dialysis prescription because of their lack of insight for the importance of PD prescription and adherence to it. As a result, they often encounter various medical problems such as volume overload, electrolyte imbalance, or uremic syndrome, which could lead to fatal conditions. Therefore, we should educate and guide PD patients well on PD prescription and stick to it for themselves to avoid those difficulties and the way to solve their ordinary but potentially serious problems. In addition, we should do our best to improve quality of life as well as the survival rate and other medical outcomes by trying to guarantee autonomy and flexibility of PD patients. The importance of personalization has been emphasized across the medicine in modern era.
M.J. Lee, M.D. Division of Nephrology and Department of Internal Medicine, CHA University, Pocheon, South Korea D.-R. Ryu, M.D. (*) Division of Nephrology and Department of Internal Medicine, Ewha Womans University, Seoul, South Korea e-mail: [email protected]
In particular, prescription of PD should be tailored to the medical condition and preference of patients. Compared with HD, PD patients more often participate in the decision process of treatment and perform dialysis by themselves. Therefore, comprehensive aspect regarding both objective indicators and subjective consideration of patients is mandatory for us to prescribe PD optimally. In this chapter, we will look at prime determinants for optimal PD, PD prescription at first, and strategies of prescription adjustment for optimal PD during maintenance of PD.
14.1 F actors for Determining PD Prescription Providing optimal dialysis is the primary goal of treatment in patients undergoing PD, which is ultimately associated with clinical outcomes. For obtaining “optimal PD dose,” we first need to identify what the important issues are for determining optimal PD dose and understand what’s the meaning of minimum dialysis dose that should be performed. “Adequate” and “optimal” dialysis has been differently defined (NKF-DOQI 1997). An “effective dose” is that which achieves its stated goal. That goal is some form of outcome measure(s) and could be determined by the patient, provider, payer, regulator, or a combination of these parties. At the lower extreme is the “minimal effective dose.” In certain circumstances this may be interpreted as
© Springer Science+Business Media Singapore 2018 Y.-L. Kim, H. Kawanishi (eds.), The Essentials of Clinical Dialysis, https://doi.org/10.1007/978-981-10-1100-9_14
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M.J. Lee and D.-R. Ryu
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Adequate solute clearance
Maintenance of euvolemia
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