Questions About PD
For high transporters, to optimize ultrafiltration, the cycles should be shortened, that means increasing the frequency or number of exchange of CAPD to achieve the amount of ultrafiltration needed. But many high transport patients have negative ultrafiltration for the overnight dwell. To overcome this problem, one may consider having dry night, i.e. Day ambulatory PD (DAPD), particularly in patients with significant residual renal function. It is important to balance it against adequate clearance as well. On the whole, we should try to avoid regular use of high glucose concentration dialyzate as much as possible. Achieving fluid balance through liberal use of diuretics and emphasis on restricting fluid and salt intake is helpful. Use of ACEI/ARB may be helpful in decreasing peritoneal transport as suggested in a recent retrospective study.