I have a patient with ESRD and has been on the APD for the past 3 years. He has good residual renal function and the urine is more than a litre per day. He is well dialyzed, biochemically and clinically. He has good QoL. The function of tenckhoff catheter is good. Abdominal XR showed catheter tip in the pelvis. No alarm triggered from the cycler. The problem is there is no net ultrafiltration from the nightly PD (negative UF). He remains in euvolaemic state, with normal BP. PET is of high average. Shall I be overly concerned of the negative UF? Follow up to the question and answer given by Z from Australia. The patient is on nocturnal PD with dry at the daytime. Negative UF ranging from -400 to 600 cc per night of PD

Questions About PD

resolved
Public
Bee BC, Doctor/MD from Malaysia asked
I have a patient with ESRD and has been on the APD for the past 3 years. He has good residual renal function and the urine is more than a litre per day. He is well dialyzed, biochemically and clinically. He has good QoL. The function of tenckhoff catheter is good. Abdominal XR showed catheter tip in the pelvis. No alarm triggered from the cycler. The problem is there is no net ultrafiltration from the nightly PD (negative UF). He remains in euvolaemic state, with normal BP. PET is of high average. Shall I be overly concerned of the negative UF? Follow up to the question and answer given by Z from Australia. The patient is on nocturnal PD with dry at the daytime. Negative UF ranging from -400 to 600 cc per night of PD

1 answer

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.

#1

Please login to submit an answer