Most patients can attain the current adequacy standards of therapy with automated PD, but few (less than 25%) can do so with standard CAPD in the absence of residual renal function.

Aim: To evaluate the effect of PD Plus on weekly Kt/V_urea and creatinine clearance (K_cr) among patients undergoing CAPD/CCPD (continuous ambulatory peritoneal dialysis/continuous cyclic peritoneal dialysis). Methods: The kinetic studies of 92 CAPD and 18 CCPD patients who transferred to PD Plus were analyzed. All patients underwent CAPD/CCPD and PD Plus for a minimum of 3 months. Standard collection methods were used and kinetic indices calculated with the Pack PD Kinetic Modeling program. 57 patients had transport data and were modeled for a target weekly Kt/V_urea ≥2.1 using PD Plus with ≤15 liters dialysate/day. 6 patients were supervised during the collection periods by research nurses. The actual results for all patients (110) and for the supervised patients were compared against the modeled results. Results:45% of the patients achieved a Kt/V_urea ≥2.1 and 47% a K_cr ≥60 liters/1.73 m² with PD Plus, but only 20% did so with CAPD/CCPD. A close correlation between the supervised patients and modeled therapy was observed. Conclusions: Adequate dialysis is possible by using higher fill volumes, the supine position, and optimal dwell times (PD Plus) in most patients. The discrepancy between modeled and achieved dose is likely due to poor compliance with therapy, inadequate training, or poor specimen collection.

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