CASES – PD ADEQUACY
October 26, 2016
Case 1
A 70 year old male patient starts CAPD because of end-stage renal failure
secondary to glomerulonephritis (he does not want to use a cycler). The patient
weighs 70 kg, has a body surface area of 1.73m² and an estimated V of 40 litres.
PET shows that the patient is an average transporter with a D/P Cr of .065. The
patient is prescribed 4 x 2L dwells daily and ultrafiltrates reasonably well. There
is also a good urine output.
Kt/V and Cr Cl measured at 4 weeks are 2.75 (150 peritoneal + 1.25 renal) per
week, and 125 litres (45 peritoneal + 80 renal) per week, respectively.
18 months later, the patient reports fatigue, anorexia and insomnia. There is mild
ankle edema and hypertension. Kt/V is now 1.6 per week and corrected Cr Cl is
45 litres per week.
Explain the patient’s symptoms and suggest a variety of strategies that might
help to improve the patient’s condition while maintaining him on CAPD.
Case 2
A 48 year old female with end-stage renal disease secondary to diabetes is
commenced on APD. She weighs 75 kg and has a body surface area of 1.73m².
PET shows that she is an average transporter with a D/P Cr of 0.65. She has a
good urinary output.
Her initial prescription is 5 x 2L dwells delivered over an 8 hour period. On this,
her Kt/V at one month is 2.0 (1.20 peritoneal + 0.8 renal) per week; her Cr Cl is
65 litres (30 peritoneal + 35 renal) per week. She reports that she is
symptomatically well.
18 months later, she reports increasing fatigue, nausea and malaise. Repeat
Kt/V is 1.4 per week and repeat Cr Cl is 35 litres per week.
Discuss the potential strategies to increase clearance on APD and their relative
merits.
The initial strategy used is partly successful for 6 months but urine output
declines to zero and malaise and fatigue recur. Suggest other strategies that
might be effective to keep the patient on APD.
Case 3
A 52 year old patient with end-stage renal failure weighs 72 kg and is
commenced on CAPD 4 x 2.5L dwells daily. Initially, he does well with good
control of volume status and at one month is reported to have a Kt/V of 2.3 per
week with a corrected Cr Cl of 70 litres per week.
After 12 months, however, he presents with hypertension and edema, and he
reports an inability to achieve his target weight.
Outline an approach to this case.
Case 4
A 65 year old female commences CAPD for end-stage renal failure of unknown
cause. She weighs 70 kg, has a body surface area of 1.4m² and a V of 28 litres.
PET shows that she is a high transporter with a D/P Cr of .085. She is
prescribed CAPD 4 x 2L daily. She ultrafiltrates 0.6 litres a day on average but
has good urine output. Initial Kt/V at one month is 2.5 (2.0 peritoneal + 0.5 renal)
per week. Initial Cr Cl is 86 litres (56 peritoneal + 30 renal) per week.
What potential risks does this patient face on CAPD?
Two years later, urine output is minimal and ultrafiltration remains poor. She
reports that her morning bag contains only about 1 litre of effluent. She now
weights 78 kg, her Kt/V is 1.8 per week and her Cr Cl is 51 litres per week.
Discuss possible options to maintain this lady on PD.