Questions About PD
We thank you for your question. For funding purposes, home dialysis centers in the United States have to report every four months Kt/V results on all their home PD patients to the Centers for Medicare & Medicaid Services (CMS), a federal agency of the US government. The measuring standard considers adequate dialysis doses as Kt/V urea > 1.7 for adult patients and Kt/V urea > 1.8 for pediatric patients. (CMS Conditions for Coverage:http://www.cms.gov/Regulations-and-Guidance/Legislation/CFCsAndCoPs)
We conducted a small survey of members of our ISPD Nursing Committee to try to answer your specific question. Our response is: The combination of CAPD and APD in one week for your patient makes the calculation of Kt/V difficult. One option is to do the whole Kt/V calculation as though the patient is on CAPD 7 days a week, to keep it simple.
We would also like to comment that today, for patients on PD, there is much more of an understanding that the well-being of the person on dialysis is related to many different factors, including: patient reported outcome measures; fluid status; nutritional status; as well as removal of toxins (1).
1.Brown EA, Blake PG, Boudville N, Davies S, de Arteaga J, Dong J, Finkelstein F, Foo M, Hurst H, Johnson DW, Johnson M. International Society for Peritoneal Dialysis practice recommendations: Prescribing high-quality goal-directed peritoneal dialysis. Peritoneal Dialysis International. 2020 May;40(3):244-53. Available at: https://journals.sagepub.com/doi/pdf/10.1177/0896860819895364