Peritoneal Dialysis Prescription and Adequacy in Clinical Practice: Core Curriculum 2023

Abstract

As the global prevalence of peritoneal dialysis (PD) continues to grow, practitioners must be equipped with prescribing strategies that focus on the needs and preferences of patients. PD is an effective form of kidney replacement therapy that offers numerous benefits to patients, including more flexibility in schedules compared with in-center hemodialysis (HD). Additional benefits of PD include salt and water removal without significant changes in patient hemodynamics. This continuous yet gentle removal of solutes and fluid is associated with better-preserved residual kidney function. Unfortunately, sometimes these advantages are overlooked at the expense of an emphasis on achieving small solute clearance targets. A more patient-centered approach emphasizes the importance of individualized treatment, particularly when considering incremental PD and other prescriptions that align with lifestyle preferences. In shifting the focus from small solute clearance targets to patient needs and clinical goals, PD remains an attractive, patient-centered form of kidney replacement therapy.

Keywords: Adequacy; PD prescription; creatinine clearance; end-stage renal disease (ESRD); incremental PD; kidney replacement therapy (KRT); modality switch; patient-centered care; peritoneal dialysis (PD); review; shared decision-making; solute clearance; transporter status; ultrafiltration capacity; volume overload.