High transporter PD ultrafiltration failure — ESENeph MCQ

Correct answer: E — Use shorter glucose dwells with a long icodextrin dwell

The best answer is “Use shorter glucose dwells with a long icodextrin dwell”. High peritoneal transport permits rapid solute equilibration but also rapid glucose absorption. Shorter glucose dwells preserve the osmotic gradient, while icodextrin supports sustained ultrafiltration during the long dwell. “Lengthen every glucose dwell to maximise diffusion time” is less appropriate because a high transporter absorbs glucose rapidly, so a longer dwell promotes loss of ultrafiltration and eventual fluid reabsorption “Stop peritoneal dialysis immediately without testing prescription changes” is less appropriate because the transport phenotype can often be managed by adapting dwell length and osmotic agent “Increase dietary sodium to strengthen the osmotic gradient” is less appropriate because higher sodium intake worsens thirst and extracellular volume rather than correcting membrane transport “Use a low-glucose solution for the longest dwell without icodextrin” is less appropriate because a weak glucose gradient is particularly likely to dissipate during a long dwell in a high transporter

Reference: ISPD guidance on peritoneal dialysis prescription: https://pmc.ncbi.nlm.nih.gov/articles/PMC5691857/