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High Transporter PD Prescription — ESENeph MCQ

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ModeratePeritoneal DialysisHigh Transporter PD PrescriptionESENeph

A 50-year-old man with CKD G5D on PD has been on PD for 5 years. His most recent PET shows he has become a high transporter (D/P creatinine 0.81). He has persistent fluid overload. What PD prescription change and adjunct are most appropriate?

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Correct answer: D — APD with short overnight dwells plus Icodextrin for the long day dwell

High transporters have rapid solute equilibration, meaning glucose is quickly absorbed and the osmotic gradient dissipates during long dwells, resulting in poor ultrafiltration. Short, frequent overnight dwells on APD maintain the osmotic gradient. Icodextrin (a glucose polymer) provides sustained osmotic UF over the long day dwell through colloid osmosis (not absorbed as quickly as glucose). This combination optimises both solute clearance and fluid removal for high transporters.

Reference: ISPD 2015 – PD Prescription; UKKA 2017 – PD Guideline