Peritoneal Dialysis Guidelines

Initiation and Prescription

The American Journal of Kidney Diseases recommends waiting 10 days to 2 weeks after catheter placement before starting peritoneal dialysis whenever possible, and if dialysis must be started in less than 10 days, performing low-volume, supine dialysis only 2
For patients with estimated GFR < 2 mL/min choosing CAPD, the American Journal of Kidney Diseases suggests the following initial prescription guidelines based on body surface area (BSA):
For patients choosing CCPD, the American Journal of Kidney Diseases suggests the following initial prescription guidelines based on body surface area (BSA):

Baseline peritoneal membrane transport characteristics should be established 4 to 8 weeks after initiating daily peritoneal dialysis therapy, according to the American Journal of Kidney Diseases 3
The standard Peritoneal Equilibration Test (PET) is the most commonly used method, involving a timed 4-hour dwell with 2.5% dextrose solution, measuring dialysate-to-plasma (D/P) ratios for creatinine and other solutes, and classifying patients as low, low-average, high-average, or high transporters 3, 4, 5
The International Society for Peritoneal Dialysis recommends a modified PET using 3.86%/4.25% dextrose to optimally evaluate patients with ultrafiltration failure 3, 4, 5

Peritoneal dialysis achieves only 10-20% of normal kidney clearance for urea and creatinine, with even lower clearance for higher molecular weight solutes, as stated by Praxis Medical Insights 1
Middle molecule clearance is maximized by continuous 24-hour dialysis without dry periods, as it depends more on total dialysis time than dialysate flow rate, according to Praxis Medical Insights 1
Tubular secretive and reabsorptive function is not replaced, endocrine function of the kidney is not replaced, and continuous protein loss occurs and can contribute to malnutrition, as noted by Praxis Medical Insights 1

Peritoneal membrane transport testing should be repeated when clinically indicated, as transport characteristics can change over time, according to the American Journal of Kidney Diseases 6, 3
Approximately 85% of patients on automated peritoneal dialysis will need one or more daytime dwells added to their prescription, as stated by the American Journal of Kidney Diseases 2
Instilled volumes almost certainly will need to increase over time as residual kidney function declines, according to the American Journal of Kidney Diseases 2

Do not perform formal peritoneal equilibration testing during the first 4 weeks of therapy, as initial instillation of dialysate causes mild changes in local cytokine production, peritoneal vascularity, and blood flow that affect transport measurements, as recommended by the American Journal of Kidney Diseases 3, 4, 5