1. Is my measured weekly Kt/V 1.7 or higher for CAPD?
2. Does my measured weekly creatinine clearance in liters indicate I am receiving adequate dialysis? What is my prescribed weekly creatinine clearance?
3. If my weekly Kt/V and/or weekly creatinine clearances are low, what can I do to increase them?
4. Is my peritoneal membrane function changing?

Discuss with your medical team these tips on getting enough PD, maintaining the correct fluid volume and preserving residual kidney function.

1. Although the Kt/V recommendations have been lowered to 1.7 per week, patients who are not doing well at this dose should have their prescription increased.

2. Residual kidney function should be measured every two months if the patient has greater than 100 mL/day urine volume and every four months if
less than 100 mL/day. Steps to preserve kidney function include the use of medications such as an ACE inhibitor (Angiotensin Converting Enzyme Inhibitor) or an ARB (Angiotensin Receptor Blocker). In addition, the blood pressure should be closely monitored and controlled. A salt restricted diet will help control blood pressure.

3. The toxic molecules removed by the kidneys come is all sizes. Some are known as “middle molecules,” and while they are difficult to measure, they can cause symptoms. Continuous dialysis or a day dwell will help eliminate them once residual kidney function has deteriorated.

4. The PET test should not be performed until a patient has been stable and on dialysis for at least 4 to 8 weeks. It should not be performed for at least one month after an episode of peritonitis. Any change in the clinical condition that may appear is the result of under dialysis or inadequate fluid removal dictates the PET test be repeated. Carefully observe drain volumes and drain times following severe peritonitis episodes, illnesses or hospitalizations.

5. The peritoneal creatinine clearance is no longer recommended. Creatinine clearance is still measured by some doctors as an indicator of phosphorous—even if it is no longer required, it may still be tested by some.

6. The serum albumin, dietary protein  intake, metabolic acidosis status, salt and processed food history are also important. These should be discussed regularly with the doctor and dietitian. The serum albumin level should be 3.8 to 4.0 mg/dL (or normal for the laboratory testing it). A low serum albumin indicates malnutrition that can be due to poor dietary intake. It may also indicate under-dialysis or a chronic medical condition.

7. Salt restriction is essential but underemphasized. It is highly challenging, but very desirable and effective in promoting good volume and blood pressure control. Sodium is used in food processing, so patients should discuss how to read food labels carefully with the dietitian – and with the grocer.

8. To help control fluids and blood pressure, the lowest effective dose of dextrose concentration should be used.

9. The dialysis prescription should be adjusted so drain volumes will be optimized and ultrafiltration will not be negative.

10. Diuretics may be helpful to control blood pressure and fluids in patients with residual kidney function.

11. Routine clinic visits monthly and evaluation by doctor and PD staff: to check for symptoms of inadequate dialysis, determine if the patient’s peritoneal exchanges are going smoothly, confirm blood chemistries are stable, and evaluate general health and nutrition.