for the use of 4.25% dwell, it is noted 4 hour is optimal, is this the case in all membrane types

Questions About PD

Nicky Warnecke, Nurse from Perth Western Australia asked
for the use of 4.25% dwell, it is noted 4 hour is optimal, is this the case in all membrane types

1 answer

Nurse Canada with members of the ISPD Nursing Committee March 21, 2024

We thank you for your question. We answered a very similar question posted to the ISPD website in 2022. In general, the average ultrafiltration (UF) rate when a patient uses a 4.25% dextrose PD solution can be as much as 300 cc to 400 cc/hour at the beginning of the dwell, but will decrease as glucose is absorbed across the peritoneal membrane (1, page 459). However, the actual UF rate will vary depending on the transport characteristics of your patient’s peritoneal membrane as determined by a PET (Peritoneal Equilibration Test). For example, if your patient on the PET has high transport characteristics, over a 4-hour dwell using a 4.25% dextrose PD solution, the patient will UF approximately 800 cc of fluid; whereas if your patient has low transport characteristics on the PET, then this patient will UF approximately 1400 cc of fluid over a 4-hour dwell using a 4.25% dextrose solution. (2, page S20, Figure 6). Similarly, the peak UF for a patient with high transport characteristics using a 4.25% dextrose PD solution will be around 4 hours, but around 9 hours if your patient on the PET has low membrane characteristics (2).
 
Today, regular use of a 4.25% dextrose PD solution is not recommended for management of a patient’s increased fluid volume for the following reasons: may adversely affect the peritoneal membrane function; will cause increased glucose absorption leading to worsening control of blood sugars; and can promote obesity. Instead, patients with increased fluid volume should be counselled, by a dietician if available, to decrease their dietary salt and fluid intake. Use of Icodextrin for the overnight dwell for a patient on CAPD is another option if your patient is a “high transporter” to manage fluid volume problems or for the daytime dwell if your patient is on automated peritoneal dialysis (APD), providing Icodextrin is available for your patients.
 
We would like to add that sodium sieving is one of the disadvantages of using a 4.25% dextrose PD solution in short dwells to correct fluid overload problem. Such shorter dwell times may lead to increased serum sodium, resulting in increased thirst.
 
1.Daugirdas JT, Blake PG, Ing TS. Handbook of dialysis 5th edition. US: Lippincott Williams & Wilkins. 2015.
 
2.Mujais S, Vonesh E. Profiling of peritoneal ultrafiltration. Kidney International. 2002 Oct 1;62:S17-22. Available at:  https://www.kidney-international.org/article/S0085-2538(15)48815-5/fulltext

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