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Low Transporter PD Volume Increase — ESENeph MCQ

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ModeratePeritoneal DialysisLow Transporter PD Volume IncreaseESENeph

A 48-year-old woman on peritoneal dialysis has a PET showing D/P creatinine 0.52 at 4 hours and ultrafiltration of 650 mL with 2.27% glucose. She is on CAPD with four daily exchanges. She complains of inadequate solute clearance (weekly Kt/V 1.5, target >1.7). What is the most appropriate modification?

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Correct answer: D — Increase exchange volume from 2 L to 2.5 L

This patient is a low-average transporter (D/P Cr 0.52) — she achieves good ultrafiltration (solute equilibrates slowly, maintaining osmotic gradient) but has relatively slow solute clearance. For inadequate Kt/V in low transporters, increasing exchange volume (from 2 L to 2.5 L, body habitus permitting) is the most effective way to increase peritoneal clearance. Longer dwell times are already inherent in CAPD. Short-dwell APD would worsen clearance in a low transporter. Icodextrin is primarily for UF optimisation. The exchange volume increase provides more dialysate surface contact and more solute removal per exchange.

Reference: ISPD 2020 – Peritoneal Dialysis Prescription; UKKA 2019 – PD Adequacy Guidelines