The PD prescription (target weekly Kt/V) determines the number of exchanges, fill volume, the concentration of dialysate and for automated PD, the machine settings. The patient may be required to bring to the unit all the dialysate bags (or take a small sample from each bag) used over a 24-hour period.

Routine evaluation by the medical team is recommended on a monthly basis. The actual amount of dialysis the patient receives depends on how completely he/she carries out his/her prescribed exchanges and dwell times for CAPD or APD. Inadequate dialysis and uremic symptoms may occur if the patient misses exchanges, reduces fill volume or shortens dwell time. Remember, PD replaces less than 15 percent of normal kidney function; there is really no room for missing exchanges, reducing fill volume or shortening the time fluid is in the belly. To be sure the patient’s general condition is stable and not having exchange or other health problems, the medical team will evaluate the patient’s condition on a regular basis. Before a visit, always think carefully about what needs to be discussed and be truthful when asked if there are any symptoms of uremia, or any other health problems. If the patient misses exchanges, reduces fill volume or shortens the cycler time, tell the caregivers. They need that information to improve a patient’s care, and may be able to provide the patient with more acceptable alternatives and treatment schedules. In addition to dialysis adequacy, it is essential patients and the healthcare team work closely together to preserve residual kidney function and to avoid cardiovascular complications such as uncontrolled hypertension and congestive heart failure. Furthermore, controlling vascular calcification and atherosclerosis are crucial to good care, and are discussed in other advisories.

To decrease your risk of a premature death, and decrease the chances of feeling tired and weak, losing weight, having a poor appetite and nausea, patients must receive adequate and proper dialysis regularly, but also work to maintain residual kidney function, and make sure volume status is under control.