Questions About PD
We thank you for your question. 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 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 will promote obesity. Instead, patients should be counselled, by a dietician if available, to decrease their fluid and salt 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, providing Icodextrin is available for your patients.
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