Questions About PD
We thank you for your question. We are not aware of specific guidelines for the management of fluid volume with different PD solutions to attain the estimated dry weight (goal weight, target weight or euvolemia) for a patient on PD. At the same time, avoiding hypervolemia (volume overload/overhydration) or hypovolemia (volume depletion/dehydration) is extremely important. Each patient on PD will need an individual plan depending on his/her: peritoneal membrane characteristics (from the results of PET, will be a fast, average, or slow transporter); residual renal function (can also vary, with some patients having no urine output); fluid and salt intake; and PD prescription.
In general, 4.25% PD solutions should be avoided because of the possible detrimental effect of the high glucose concentration on the peritoneal membrane and on the blood glucose of PD patients with diabetes. Moreover, for patients with low or no residual renal function, a consult with a dietician should be considered to help the patient restrict his/her salt and fluid intake, thus limiting use of 4.25% PD solutions. If you have access to Icodextrin for your patients on PD, once-a-day use of Icodextrin for the long dwell can be most helpful in managing the fluid status of these patients.