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APD prescription: Achieving the adequacy goals
No full textIn the last few years, automated peritoneal dialysis (APD) has undergone considerable improvements due to technological developments. The definition of a minimal dose of peritoneal dialysis (PD) has not yet been completely assessed. Appropriate use of APD requires an evaluation of dialytic efficiency in terms of dialytic indexes and their targets. Many dialytic treatment modalities have been performed in order to achieve adequacy targets. Some aspects have to be taken into consideration to reach the optimal dialytic dose: optimizing mass transfer in correlation with intraperitoneal volumes, prescribing tailored treatment modalities according to different characteristics of peritoneal membranes and individual patient needs, and performing more biocompatible treatments using different glucose pro ling and alternative physiologic PD fluids. New high-flow techniques such as continuous flow PD can ensure better urea and creatinine clearances and ultrafiltration rates, leading to a higher utilization of the APD modality
Acid-base balance in peritoneal dialysis
No full textIn patients without functioning kidneys, alkali replenishment is accomplished by the addition, via dialysis solution, of either HCO3- itself or a metabolic precursor of this anion, such as lactate. The body base balance in peritoneal dialysis (PD) patients is self-regulated by the feedback between plasma bicarbonate concentration and dialytic base gain. Dialytic base gain is the only source of buffer for PD patients and this gain should counteract the metabolic acid production. Dialytic base gain depends on peritoneal buffer fluxes (lactate reabsorption minus bicarbonate lost). The plasma bicarbonate level is determined by the dialytic base gain and the metabolic acid production. Bicarbonate buffered PD solution provides some advantages over the conventional lactate buffered PD solution
Successful use of Amuchina (Sodium chloride 18%) pack, systemic and local an tibiotic therapy for tthe treatment of pseudomonas infection of the PD (Peritoneal dialysis) catheter exit-site
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Integration of peritoneal dialysis in the treatment of uremia
No full textThe real integration of a specific therapy into the renal replacement program is represented by the possibility of easy and free patient transfer from one treatment to another without restrictions. In the case of peritoneal dialysis we feel that its integration in the therapeutic approach of uremia represents an ethical obligation for the physician, a clinical opportunity for the patient and a good cost/benefit solution for care givers. A full conviction that peritoneal dialysis represents a real therapeutic option for ESRD patients is necessary to achieve a real integration of this therapy in the uremia treatment program. A positive cost benefit ratio, both from the clinical and the economical points of view must also be seeked. The patient indirectly, must receive the same positive conviction, based on solid data and clinical results, comparable to those achievable in hemodialysis. Furthermore the patient must know that such treatment will provide an equal opportunity for kidney transplant compared to other therapies. Such a kind of feeling and knowledge must include information on patient's survival, rate of complications, treatment adequacy, availability of different techniques within the treatment and complete summary of advantages and disadvantages. Copyright (c) 2006 S. Karger AG, Basel
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