The critical role of prescription management in a peritoneal dialysis program

Abstract

Prescription management for patients on renal replacement therapy requires consideration of a wide range of interrelated conditions including dialysis therapy, medications for co-morbid conditions and nutrition. Optimal outcomes cannot be achieved by focusing on solute clearances alone because outcomes are dependent on a constellation of factors related to control of the patient’s disease. Hence, the adequacy of dialysis involves attention to controling co-morbid conditions as well as correction of the consequences of renal failure. Table 22.1 contains a partial list of the components of adequacy in renal replacement therapy. While dialysis addresses many of these components, additional measures are necessary to attain optimal outcomes. Blood pressure control, improved anemia, and better calcium-phosphate metabolism are achievable through adequate dialysis prescription, but additional antihypertensive therapy, erythropoietin administration and increased vitamin D intake are essential for optimal care. Thus, while the present chapter focuses on the elements of dialysis prescription management, the recommendations discussed herein must always be taken in the context of overall patient management.