As I have previously reported, I recently underwent a dialysis PET to ascertain the status of my peritoneal membrane transport function. Initially, it was calculated to be “low average” and my prescription calculations were based upon this. The latest PET indicates my transport function is now high average which necessitates a new prescription to take advantage of the revised data.
Recall that all of this is an attempt to drive my Kt/V into the 2.0 range from the current 1.7-1.8 range (at the low end of acceptable) where Kt/V is a measurement of how well my dialysis is functioning. In this case, more is better.
So as of Wednesday 1/2/2024, my new prescription is five dwells of one hour thirty minutes each with 2700 ml of dialysis fluid. All else being equal, this works out on paper to take the same time as my current prescription but takes advantage of my higher transport by running more fluid “faster” through my stomach lining and more often.
The first of February 2024 I am to have another adequacy test where we will ascertain what my Kt/V is under the new prescription and go from there. Hopefully it will be knocking on the door of 2.0.
Now I have to figure out how to best deal with the physical requirements of the new prescription on ordering and storing of increased dialysis fluid supplies. As a first cut, I’m going to continue to use 5000 ml bags, three each evening, and discard 1500 ml every morning. I will probably have to order more 5000s or get some from my dialysis nurse before the next scheduled order/delivery cycle since this is a 33% bump in usage from my previous prescription.
If there is a point in all of this it’s Flexibility in treatment plans: Peritoneal dialysis may require adjustments to treatment plans over time. Factors such as changes in health condition, fluid balance, or lifestyle may necessitate modification to the dialysis prescription. Accepting these changes enables patients to work closely with their healthcare team to ensure that the treatment remains optimal and tailored to their specific needs. This change was not dictated to me. We discussed the pros and cons and agreed to proceed. Patients do have an oar in the water.
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