GETTING STARTED: PATIENT PATHWAY TO FIRST PRESCRIPTION
This guide was designed to assist clinicians through the process of individualizing a patient’s prescription. Sample dialysis prescriptions are based on Volume of Urea Distribution (Vurea), Residual Kidney Function (RKF) and Peritoneal Membrane Type. The sample prescriptions are intended as an aid in achieving recommended clearance goals; however, other prescription options may also exist.
If a patient develops any of the following: uremic symptoms, decline in nutritional status and/or decreased measured clearances, consideration should be given to using prescription management software to create a prescription based on patient-specific parameters.
Adequacy and Ultrafiltration Goals
- The minimum delivered weekly Kt/Vurea of 1.7 represents peritoneal clearance alone or peritoneal plus renal clearance4
- While the Kidney Disease Outcomes Quality Initiative (KDOQI) guidelines do not recommend use of creatinine clearance to assess adequacy, creatinine clearance goals of 45 L/wk in APD patients are advocated by the International Society of Peritoneal Dialysis (ISPD) and other organizations4-9
- Euvolemia is critical to improve patient outcomes4
- While no recommendation regarding an ultrafiltration (UF) target exists in the United States, other countries recommend an arbitrary UF target of 750–1000 mL/day in anuric patients, based upon improved outcomes in observational studies7, 8, 10
Individually tailored prescriptions are essential for good prescription practices. Knowledge of Volume of Urea Distribution, Residual Kidney Function and Peritoneal Membrane Type are fundamental to the PD prescription.11 These three parameters are required to appropriately use this Peritoneal Dialysis Prescription Management Guide. Assessment of these factors is described on the pages that follow
