Questions About PD
Thank you for your question.
Inadequate peritoneal UF can result from 4 mechanisms:
- catheter dysfunction,
- mechanical problems (incl. sequestration or excessive fluid absorption),
- membrane failure (including EPS),
- inadequate prescription.
It would be interesting to know if the immediate drainage after instillation works well, and if icodextrin generates a positive UF after a dwell lasting 8-12 hours.
Then, would suggest:
- to perform a peritoneal equilibration test (ideally using hypertonic glucose during a 4-h dwell) to assess net UF (is it UF failure?), peritoneal solute transport rate (fast transport status?), and sodium sieving (i.e. altered osmotic conductance, potentially suggesting severe membrane fibrosis and an increased risk of EPS?);
- to consider imaging studies, including: X-ray of the abdomen (location of the tip of the catheter?), CT scan of the abdomen (signs of EPS?) and/or, based on results of previous tests, a CT peritoneography (adhesions? sequestration? other causes for abnormal drainage?).
The results of the workup should then help choosing the best solution (catheter replacement, adaptation of prescription, or transition to HD? – or adhesiolysis if restricted to an area of the abdomen?).
Hope it helps. Do not hesitate to provide a feed-back and/or ask additional questions.