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Low-Average Transporter PD Optimisation — ESENeph MCQ

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ModeratePeritoneal DialysisLow-Average Transporter PD OptimisationESENeph

A 50-year-old man on PD has a PET showing he is a low-average transporter (D/P Cr 0.55). He achieves good UF but borderline small solute clearance on CAPD with 4 exchanges. What prescription optimisation could improve clearance?

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Correct answer: E — Increase fill volume (if tolerated) or add an extra CAPD exchange – low-average transporters need longer dwells for solute equilibration; increasing the number of exchanges per day or fill volume improves total clearance without changing dwell time

Low-average transporters equilibrate slowly, meaning they retain good osmotic gradients (good UF) but achieve less solute removal per exchange than high transporters. To improve clearance: (1) increase fill volume (e.g. 2.0L to 2.5L – increases peritoneal surface area contact and total solute removal); (2) add an extra exchange (5th exchange or small overnight exchange); (3) ensure adequate dwell time (CAPD preferred over APD for low transporters). Icodextrin is less needed in low transporters (they achieve good UF with glucose) but may be useful if one long dwell is used.

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