As individual
as your patients
PD therapy tailored to patients' needs
Your patients have a chronic kidney disease in common, but they differ in many ways: age, height, weight, stage of illness, residual renal function etc. These differences have a decisive impact on the required PD treatment:
Patients' needs are different.
Important parameters for successful PD:
Age
Age is an important factor influencing the choice of dialysis modality. Patients with good dexterity and motivation are good candidates for PD. With increasing age, the associated comorbidities of dialysis patients might deteriorate and with it their frailty.
Weight
Optimal management of weight is an important success factor in PD patients. Changes in weight due to lifestyle, calorie intake, disease and hydration status need constant monitoring and adaptation of PD therapy.
D/P creatinine
Dialysate to plasma ratio is a common measure used to evaluate peritoneal transport characteristic in PD patients. Patients can be fast, average or slow transporters depending upon the status of their peritoneal membrane. Peritoneal membrane transport characteristics change with time on PD. Therefore, regular monitoring of D/P creatinine and subsequent adjustment of PD prescriptions is recommended.
Transporter type
Patients are classified into fast, average and slow transporters based on the function of their peritoneal membrane. With time and increasing duration of stay on PD, patients tend to become fast transporter. PD prescriptions need to be adapted according to patients transport status for an optimal patient outcome.
Residual renal function (RFF)
RRF has an impact on patient survival and quality of life of PD dialysis patients. Its longer preservation is a major advantage. Thus, interventions to preserve RRF like prescription of biocompatible PD fluids are important.
Ultrafiltration (UF)
Due to compromised renal function, bodies own capacity to remove excess fluid also diminishes and patients need dialysis to generate UF. The amount of UF needed varies depending upon many factors, like lifestyle, disease progression and other co-morbid conditions. An adequate UF is therefore critical for successful PD.
Kt/V urea
Kt/V urea is urea clearance normalized to total body water. It is an important parameter to check PD adequacy. A total Kt/V urea of at least 1.7 per week is recommended for PD patients.
Different patients, different settings
Fresenius Medical Care is offering a comprehensive peritoneal dialysis (PD) programme including adapted APD with sleep·safe harmony which enables mixed cycles with varying dwell times, dwell volumes and glucose concentrations.
Reaching adequacy targets in PD for both ultrafiltration (UF) and clearance is challenging. Fischbach et al. propose that shorter dwell times and smaller fill volumes promote the process of UF, while longer dwell times and large fill volumes increase solute clearance.1
The proposed strategy may have the potential to improve the two targets within one PD session.
Modified graphic of an aAPD prescription following Fischbach M. et al., 2011, (page 3)1
Summary of study results on adapted APD compared to conventional APD by Fischbach et al.1
Patient benefits:
- Improves UF
- Better sodium removal
- Lower blood pressure
- Promotes clearance: urea, creatinine, phosphate
- Reduced metabolic load
Clinical value:
- Efficiently uses existing treatment resources: better UF and clearance with same, low glucose concentration, fluid volume and treatment time compared to cAPD.
sleep•safe harmony enables:
- Complete individualisation for a fully personalised treatment
- Treatment supported by FlexPoint technology
- Guided prescription on the cycler or via PatientOnLine software
Fictitious patient cases underlie that each patient is different and that treatments must be adapted accordingly. Patients’ needs are different.
Patient A - Elisabeth:
At the start of aAPD the patient (fast transporter) had residual renal function (urine) of 1500 ml/24h and good solute clearance. Prescription was 5 X APD therapy. Treatment continued for 2 years.
Due to disease progression, UF decreased and urine declined to 400 ml.
When she was started on aAPD, with 1.5% glucose solution and short term 2.3 % to alleviate fluid overload.
Fictitious patient cases underlie that each patient is different and that treatments must be adapted accordingly. Patients’ needs are different.
Patient B - Jack:
Patient is diabetic (slow transporter) and started receiving APD for about 2 years. At least once a week in HD, because he was fluid overloaded. RRF also started to decrease gradually.
aAPD with same amount of fluid volume and time as before was started. 2 cycles of 1500 ml with 4.25 % glucose solution in the beginning to remove excess water and treatment continued with 1.5% glucose.
Key features of the sleep•safe harmony cycler
sleep•safe harmony offers advanced features aimed at improving patient care.
It also contributes to the improvement of patient compliance and saves training time.
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