what is the minimum time a patient should dwell?

Questions About PD

Chelise F, Nurse from Kolff Dialysis asked
what is the minimum time a patient should dwell?

1 answer

Johann, MD from Europe October 4, 2018

Dwell time should be adapted to every patient to achieve adequate dialysis, taking into account several factors, including the type of osmotic agent (icodextrin-based dialysis solutions requiring dwell times of >6 hours, ideally 8-12 hours), catheter patency (which influences duration of drainage) and membrane function (mainly peritoneal solute transport rate, which is best evaluated using the dialysate-over-plasma creatinine ratio at the end of the 4h-PET).
Short dwell times are typically prescribed in patients with high PSTR (fast transport status), to optimize glucose-driven ultrafiltration using automated PD.
While there is no consensual definition of the minimal dwell time, decreasing dwell time below (60-) 80 minutes does not provide any additional benefit – as transport of water and solutes (incl. sodium) takes some time to occur, and as infusion and drainage times should also be considered. In addition, very short dwell times promote free-water transport rather than solute-coupled (ie sodium) water transport, therefore failing to restore euvolemia in fluid overloaded patients with a high PSTR.
 

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