Optimising Peritoneal Dialysis: A Comparison of Adapted and Conventional Peritoneal Dialysis

Conventional Peritoneal Dialysis (Con-PD) Con-PD is delivered as a series of identical exchanges, each consisting of a fill, dwell and drain of an identical volume of dialysate. The volume of dialysate is determined as a maximum of either 40ml/kg or 1300ml/m2, depending on physician preference and patient comfort. The length of each cycle and the number of cycles are determined by the results of the annual Peritoneal Equilibration Test(PET) which defines patients as low, medium or high transporters. The overall length of the nightly dialysis programme is also determined by the lead nephrologist’s experience with the patient and what regime is most acceptable to the family in terms of solute clearance (measured by blood tests), fluid removal/ultrafiltration (determined by weight, clinical exam and blood pressure) and the impact that time on dialysis has on the child’s life (i.e. a baby will tolerate 12-14 hours on dialysis overnight whereas a teenager may be limited to 8-10 hours to facilitate school etc). Adapted PD (Ad-PD) Ad-PD is a new concept in PD and consists of several initial short, low volume cycles, followed by several long, higher volume cycles. In concept it is similar to how manual PD is frequently employed in intensive care, where there are more frequent changes made to cycle length and volume. Ad-PD uses the same machine, the same volume of fluid, and the same overall treatment time. As such there is no need for extra education of patients or parents. The trial will last 12 weeks with 6 weeks of Ad-PD and 6 weeks of Con-PD. The first week of the second treatment regime will be considered a wash-out period.