The critical role of prescription management in a peritoneal dialysis program
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.
KeywordsPeritoneal Dialysis Residual Renal Function Subjective Global Assessment Peritoneal Membrane Automate Peritoneal Dialysis
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- 3.Burkhart JM, Schreiber M, Korbet SM, Churchill DN, Hamburger RJ, Moran J et al. Solute clearance approach to adequacy of peritoneal dialysis. Perit Dial Int 1996; 16:457–70.Google Scholar
- 5.DuBois D and DuBois EF. A formula to estimate the approximate surface area if height and weight be known. Arch Intern Med 1961; 17:863–71.Google Scholar
- 6.Churchill DN, Taylor DW and Keshaviah PK. Adequacy of dialysis and nutrition in continuous peritoneal dialysis: association with clinical outcomes, Canada-USA (CANU-SA) peritoneal dialysis study group. J Am Soc Naphrol 1996; 7:198–207.Google Scholar
- 7.Twardowski ZJ, Nolph KD, Khanna R et al. Peritoneal equilibration test. Petit Dial Bull 1987; 7:138–47.Google Scholar
- 8.Durand P, Chanliau J, Gamberoni J, Hestin D and Kessler M. Measurement of hydrostatic intraperitoneal pressure: a necessary routine test in peritoneal dialysis Perit Dial Int 1996: 16:S84–7.Google Scholar
- 9.Piraiao B, Bernardini J, Sarkar S, Johnsion J and Fried L, JI, exchange volumes are tolerated by most PD patients. Perit Dial Int 1998; 18:S22.Google Scholar
- 15.Kopple JD and Blumenkrantz MJ. Nutritional requirements for patients undergoing continuous ambulatory peritoneal dialysis. Kidney Int 1983; 24:S295–302.Google Scholar
- 17.Enia G, Sicuso C, Alati G and Zoccali C. Subjective global assessment of nutrition in dialysis patients. Nephrol Dial Transp 1993; 8:1094–8.Google Scholar
- 20.Tebeau J, Moran J, Vonesh E and Harter M. Improvements in delivered dose utilizing a prescription management process. Perit Dial Int 1998; 18:S23.Google Scholar