Problems with solute clearance and ultrafiltration in continuous peritoneal dialysis
- John M Burkart, MD
John M Burkart, MD
- Section Editor — Dialysis
- Professor of Medicine/Nephrology
- Wake Forest University Medical Center
- William L Henrich, MD, MACP
William L Henrich, MD, MACP
- Professor of Medicine
- President of the Health Science Center
- University of Texas Health Science Center School of Medicine
Patients on chronic peritoneal dialysis (including both continuous ambulatory peritoneal dialysis [CAPD] and automated forms of peritoneal dialysis [APD] such as continuous cycler peritoneal dialysis [CCPD]) occasionally have difficulty achieving solute removal goals or maintaining euvolemia. Both inadequate solute removal and volume overload have multiple etiologies.
This topic reviews factors that contribute to inadequate solute removal among peritoneal dialysis patients and discusses the clearance of particular solutes. This topic also reviews volume overload among peritoneal dialysis patients and provides an approach to evaluating such patients.
The factors that regulate solute and water transport across the peritoneal membrane are discussed separately. (See "Mechanisms of solute clearance and ultrafiltration in peritoneal dialysis".)
The following discussion assumes that the peritoneal dialysis prescription was initially adequate and that solute clearance and/or fluid removal have become impaired over time. A review of the factors that must be considered at the initiation of dialysis is presented separately. (See "Choosing a modality for chronic peritoneal dialysis".)
Among peritoneal dialysis patients, total solute removal or clearance consists of the removal of the solute in question by both dialysis and residual renal clearance. The clearance of a particular solute is often used as a measure of the dialysis dose; in such cases, the term clearance refers to the amount of blood that is "cleared" of a substance over a unit of time. The dialysis dose or clearance may also be expressed by normalizing it to the particular solute’s volume of distribution that the solute was cleared from, such as Kt/V.
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- INADEQUATE SOLUTE CLEARANCE
- Poor compliance
- Loss of residual renal clearance
- Decreased peritoneal transport
- Increased peritoneal transport
- INADEQUATE ULTRAFILTRATION
- Icodextrin dialysate
- Use of diuretics
- Novel interventions
- INADEQUATE SOLUTE CLEARANCE AND ULTRAFILTRATION FAILURE
- Encapsulating peritoneal slerosis or sclerosing encapsulating peritonitis
- - Pathogenesis and causes
- - Incidence, clinical features, and diagnosis
- - Treatment
- SUMMARY AND RECOMMENDATIONS