ASSUMPTIONS ON WHICH MODELING IS BASED
Data from 1,006 randomly selected adult PD patients from 39 U.S. centers were analyzed and used to group patients according to their peritoneal membrane transport characteristics and Vurea. Based on four PET classifications and three Vurea categories, modeling was performed on PD ADEQUEST software to obtain prescriptions that would meet or exceed minimum adequacy and UF goals.11
Clearance goals have been subject to multiple revisions. The sample prescriptions provided in this guide were designed to achieve a minimum weekly delivered Kt/V of 1.7 and to minimize patient burden. The sample prescriptions must not be considered medical advice and are not a substitute for clinical judgement.11
Minimal Delivered Weekly Clearance Goal: Kt/V ≥ 1.711
Continuous Therapy: Fluid in peritoneal cavity seven days/week11
Ultrafiltration: ≥ 1.0 L/day. Adjustment of dialysis solutions including dextrose and EXTRANEAL (icodextrin) PD Solution to meet the patient’s UF requirement is necessary. UF plays an important role in obtaining clearance. Increasing or decreasing UF also impacts clearance11
Residual Kidney Function: For patients with ≥ 2 mL/min of RKF, prescriptions are based on kidney urea clearance11
CAPD: 8-hour overnight exchange11
APD: 9-hour cycler time11, 15
A glucose-sparing strategy, using 1.5% and 2.5% dextrose solutions, was applied in modeling. Under these modeling assumptions, use of 4.25% was therefore precluded. However, 4.25% dextrose solutions can be used in situations of fluid overload31
Please note: The following tables contain sample prescriptions based on patient categories. These are provided for informational purposes only and should not be considered medical advice nor should they be substituted for individual clinical judgement.
It is important that you obtain a 24-hour urine and dialysate collection so that the delivered dose is at your goal and adjust the prescription accordingly. If one were to model the prescription, there would be many other prescription options you may want to consider
PD ADEQUEST software is a clinical tool that organizes dialysis therapy data to facilitate clinical decision making and patient care. It is in no way intended to be a substitute for clinical practice or a patient chart.