Questions About PD
The negative UF is not a problem at this stage because the patient is euvolaemic and is obviously being kept out of trouble by their large residual urine output. However, the poor overnight UF will become an issue when the patient’s residual renal function declines. The nocturnal UF can be increased by optimising the dwell time according to the patient’s peritoneal transport status. I presume that they are a high or high average transporter based on their poor UF and the fact that they can adequately dialyse with just nocturnal PD (even though they have good residual renal function). This suggests that they may benefit from a short dwell NIPD regimen, but their transport status and D:P creatinine need to be known.As the residual renal function declines, they will need 1 or 2 daytime glucoes dwells or possibly an icodextrin dwell if they are a high transprter to manage UF and solute clearance.