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VS ??? ??

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CAPD guide line VS CAPD CR KT/V – PowerPoint PPT presentation

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Title: VS ??? ??

1
CAPD guide line

VS ??? ??
CAPD??
CR ??? ??

2
??? ????

?? KT/V lt 2
GFR lt10.5/min/1.73m2
DOQUI guideline 2

3
Before peritoneal dialysis

1. PD start 10 days to 2 weeks
after catheter placement.
2. If PD started in lt 10 days
following catheter placement,
?do low-volume, supine dialysis.
3. Obtain baseline 24-hour urine collection
for urea and creatinine clearance

4
Before peritoneal dialysis

4. Explain to patient/parents/caregivers that
The prescription will be individualized.
Instilled volume almost increase over time.
Their total solute clearance will be monitored
IF RRF or peritoneal transport changes,
their prescription may need to change as
well.

5
CAPD (1.5L or 2L) x qid CCPD 10 L last bag
(1L-2L) NIPD 10 L
First Prescription (Based on RRF, BSA)
1 month adjustment BSA, RRF, PET, S/S
CAPD(L, LA) CAPD(H, HA) WKt/Vlt1.7
WKt/Vlt2 WnCCrlt50 WnCCrlt60
CCPD WKt/Vlt2.1 WnCCrlt63
NIDP WKt/Vlt2.2 WnCCrlt66
???? ???? 1L-2L ?????
?????? 3??4? or 4??5?
??????? 1.5L?2L or 2L?2.5L
CCPD
HD
6
Initial prescription

(1) Full dose to meet minimal total solute
clearance goal
(2) Pt with a significant RRF, but Kt/V lt 2.0
?Incremental dosage of PD.
(3) Based on BSA and residual renal function
(4) During training, transporter type can be
predicted from drain volume during a timed (4-
hr) dwell with 2.5 glucose

7
Residual renal function

Renal GFR
1/2 (renal CCr renal UreaCr)
BSA
0.007184xBW(Kg)0.425xBH(cm)0.725

8
???????

CAPD ?????????3-4?
????
CCPD ??last bag??9??,?CAPD??1-2?
?????????4-6?
NIDP ?????????4-6?
??dry

9
GFR gt2 ml/min

A. If patient's lifestyle choice is CAPD
BSAlt1.7 m2 ?4 x 1.5 L exchanges/day
BSA 1.7 to 2 m2 ?4 x 2.0 L exchanges/day
BSAgt2.0 m2 ? 4 x 2.5 L exchanges/day

10
GFR gt2 ml/min

B. If patient's lifestyle choice is CCPD
BSAlt1.7 m2
?6 x 1.5 L (9hours/night) 1 L/d(last bag)
BSA 1.7 to 2.0 m2
?4 x 2.0 L (9 hours/night)1.5-2.0 L/day (last
bag)
BSAgt2.0 m2
? 4 x 2.0 L (9 hours/night)2. L/day
(last bag)

11
GFR gt2 ml/min

C. If patient's lifestyle choice is NIPD
Used at the initiation of dialysis.
Reserved for high or rapid transporters.
Patients with significant RRF (and ability to
diuresis),
Nightly exchanges only (dry day)

12
2. GFR ?2 ml/min

A. If patient's lifestyle choice is CAPD
BSAlt1.7 m2 ? 4 x 2.0 L/day
BSA 1.7 to 2.0 m2 ? 4 x 2.5 L/day
BSA gt2.0 m2 ? 5 x 2.5 L/day
(Consider use of a simplified nocturnal
exchange device to achieve optimal dwell
times and to augment clearance.)

13
2. GFR ?2 ml/min

B. If patient's lifestyle choice is CCPD
BSAlt1.7 m2
?6 x 1.5 L (9hours/night) 1 L/d(last bag)
BSA 1.7 to 2.0 m2
?4 x 2.0 L (9 hours/night)1.5-2.0 L/day(last
bag)
BSAgt2.0 m2
? 4 x 2.0 L (9 hours/night)2.0 L/day (last
bag)
(???????1-2?)

14
CAPD (1.5L or 2L) x qid CCPD 10 L last bag
(1L-2L) NIPD 10 L
First Prescription (Based on RRF, BSA)
1 month adjustment BSA, RRF, PET, S/S
CAPD(L, LA) CAPD(H, HA) WKt/Vlt1.7
WKt/Vlt2 WnCCrlt50 WnCCrlt60
CCPD WKt/Vlt2.1 WnCCrlt63
NIDP WKt/Vlt2.2 WnCCrlt66
???? ???? 1L-2L ?????
?????? 3??4? or 4??5?
??????? 1.5L?2L or 2L?2.5L
CCPD
HD
15
CAPD (1.5L or 2L) x qid CCPD 10 L last bag
(1L-2L) NIPD 10 L
First Prescription (Based on RRF, BSA)
1 month adjustment BSA, RRF, PET, S/S
CAPD(L, LA) CAPD(H, HA) WKt/Vlt1.7
WKt/Vlt2 WnCCrlt50 WnCCrlt60
CCPD WKt/Vlt2.1 WnCCrlt63
NIDP WKt/Vlt2.2 WnCCrlt66
???? ???? 1L-2L ?????
?????? 3??4? or 4??5?
??????? 1.5L?2L or 2L?2.5L
CCPD
HD
16
Adequate dialysis

1. Adequate solute removal ability
2. Adequate ultrafiltration

17
1st month adjustment

Depend on
Peritoneal equilibration test (PET)
Residual renal function (RRF)
Body surface area (BSA)
S/S
weekly Kt/V and total nCCr
?Adjustment of dialysis dose

18
Peritoneal Equilibration Test (PET)

????Dialysate????,??8-12hrs
?????,?PD Room???????
???20?(lt25?)????????
????10???2.5 Dialysate 2000ml?
?2?? 400ml??,???????? ? ?dialysate?????????

19
Peritoneal Equilibration Test (PET)

Dialysate??????,?0?(0-dwell time)
????200ml???,?10ml ??,??????????????????
120??,????????1/10 ?dialysate???????????,???????10
ml???,?????????????
120??????glucose, Cr ??
240??,????dialysate????20? ????,??10ml
dialysate???

20
Peritoneal equilibration test (PET)

Insertion 2 liters of 2.5 detrose dialysate
? 0??, 2??, 4??
? D/D0 glucose and D/P Cr?? ???
? Low transporter
Low everage transporter
High average transporter
High transporter

21
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24

Adequate
solute removal ability

25
CAPD (1.5L or 2L) x qid CCPD 10 L last bag
(1L-2L) NIPD 10 L
First Prescription (Based on RRF, BSA)
1 month adjustment BSA, RRF, PET, S/S
CAPD(L, LA) CAPD(H, HA) WKt/Vlt1.7
WKt/Vlt2 WnCCrlt50 WnCCrlt60
CCPD WKt/Vlt2.1 WnCCrlt63
NIPD WKt/Vlt2.2 WnCCrlt66
???? ???? 1L-2L ?????
?????? 3??4? or 4??5?
??????? 1.5L?2L or 2L?2.5L
CCPD
HD
26
???????

Weekly Kt/V
7 x (peritoneal Kt/V renal Kt/V)
Weekly nCCr
7 x (Peritoneal CCr renalGFR)/(BSA/1.73)
7 x Peritoneal CCr
1/2( renal CCrrenal
ureCr)/(BSA/1.73)

27
Target of WKt/V, WnCcr
CAPD CAPD CCPD NIPD
L, LA H, HA CCPD NIPD
Weekly Kt/V gt1.7 gt2.0 gt2.1 gt2.2
Weekly nCCr gt50 L/week gt60 L/week gt63 L/week gt66 L/week
28
?????S/S

????????
-Cr?, BUN ?or ?
-?? ???? ???
-???? ?? ?? ?? ??

29
Adjust dialysate

Kt/V and nCCr ?? or S/S
? ?dialysate ?? or
? ?????
? ??????

CAPD (L/LA) 2L qid ?Kt/V lt 1.7 or nCCrlt50
?2L change 5 ? ?2.5L change 5 ?
? CCPD (????? ??10L)
? HD
CAPD (H/HA) 2L qid ?Kt/V lt 2 or nCCrlt60
?2L change 5 ? ?2.5L change 5 ?
? APD (??10L)
? CCPD (????? ??10L)? HD

APD 10 L (1.5)?Kt/V lt 2.2 or nCCrlt66
?CCPD (?????????)
CCPD ?Kt/V lt 2.1 or nCCrlt63
?H/D

32
CAPD (1.5L or 2L) x qid CCPD 10 L last bag
(1L-2L) NIPD 10 L
First Prescription (Based on RRF, BSA)
1 month adjustment BSA, RRF, PET, S/S
CAPD(L, LA) CAPD(H, HA) WKt/Vlt1.7
WKt/Vlt2 WnCCrlt50 WnCCrlt60
CCPD WKt/Vlt2.1 WnCCrlt63
NIPD WKt/Vlt2.2 WnCCrlt66
???? ???? 1L-2L ?????
?????? 3??4? or 4??5?
??????? 1.5L?2L or 2L?2.5L
CCPD
HD
33
?????S/S

????????
-Cr?, BUN ?or ?
-?? ???? ???
-???? ?? ?? ?? ??

34
???????

???? Hb, Ht, WBC, DC, Sugar, alb, A/G,
Alk-P, Chole, TG, BUN, Cr,
Uric Acid,
Cr, K, NA, Ca, P,
????? MCV, Ret, Iron, TIBC, Ferritin,
GOT, GPT,
????? iPTH, Vit B12, Folic acid, nCCr, Kt/V
???? PET, X-ray, HBsAg, Anti-HCV

35
Adequate ultrafiltration
36
??UFF ???

????????2-3????? (4.25)????, ???????.
????????????.

37
???????

S/S
-??? ??
-?????????????

38
Management of Ultrafiltration inadequate

??dialysate ?? or
? ?????
? ??????
? ?Dextrous ??( 1.25?2.5?4.25)
? Extraneal (Icodextrin)
? ??????
? urine lt500cc/day ?Transamin1Bid

39
CAPD (2L or 1.5L ) x qid CCPD 10 L last bag
(1L-2L) NIPD 10 L
First prescription
-??? ?? -?????????????
? ?dialysate ?? or ? ?????
? ?????? ? ?Dextrous ??(
1.25?2.5?4.25) ? Extraneal
(Icodextrin) ? ?????? ? urine
lt500cc/day ?Transamin1Bid
40
????
???? ?????
?????
??2??????
??
24H urine
?????
????
?????
??
????UF
RFF??
PET
??
??
??
1.?????? 2.????? 3.???? 4.????????
Type I UFF ??????
Type II UFF 1.?????? 2.??
41
Type I UFF

70-80
Peritonitis ? ?transport effect
(D/PCr ?, D/D0 glucose?)
Reversible after 1 month

42
Type II UFF

??
Sclerosing peritonitis and
peritoneal adhesion
???????, ?????
?????UFF ?inadequate solute transport

43
Type III UFF

High lymphatic absorption rate
Uncommon

44
Type IV UFF

Aquaporin deficiency
Rare
?Water channels or ? ultra-small pore
?deficient crystalloid-induced UF
Dx lt400ml UF with 4.25PET
lack of Na sieving early in the dwell
Tx colloid osmotic agents (icodextrin)

45
Type I UFF ????? ???????? ??? ?? lasix ??NPD ??HD or ??icodetran
Type II UFF ?????? ?? ??? ?? lasix ?tidal PD ?HD
?? ??? ????
?? ?? ???? ??PD
?????? ?????? ????
Type III UFF ?????? ???????
46
Icodextrin 7.5