A load volume suitable for reaching dialysis adequacy targets in anuric patients on 4-exchange CAPD.

Continuous ambulatory peritoneal dialysis (CAPD) depuration indexes are targeted to get a minimum total weekly peritoneal urea clearance (Kt/V) of 1.70 and creatinine clearance/1.73 m(2) (pCrCL) of 50 l. In anuric patients these targets are difficult to achieve. Since dialysis volumes (load, VOLin; drain, VOLout) are the main determinants of peritoneal clearances (pCLs), we aimed to estimate the minimum volumes required to fulfill these targets in anuric patients. Sixty-nine CAPD anuric patients from eight dialysis units were observed retrospectively. Demographic data, dialysis schedule, VOLs and depuration indexes were recorded. The relationship between normalized VOLs and pCLs was estimated by linear regression analysis as a whole (95 % confidence interval of the fit) and stratified by tertiles of body weight (BW) and surface area (BSA). Mean weekly pKt/V was 1.89 +/- A 0.29, pCrCL 52.9 +/- A 8.0, VOLin 32.9 +/- A 5.3 ml/kg and VOLout 37.4 +/- A 6.7 ml/kg exchange. VOLin and VOLout correlated with depuration indexes only if normalized. A VOLin of 28.5 ml/kg exchange (27.0-30.0) was associated with a pKt/V of 1.70, and a VOLin of 29.5 (26.5-31.5) with a pCrCL of 50 l, with a VOLout of 31.7 ml/kg (29.5-33.5) and 32.4 (27.2-35.5), respectively. Smaller patients needed a lower normalized VOLin/exchange to obtain pKt/V = 1.70 (1st vs. 2nd vs. 3rd BW tertiles: 28.3 vs. 28.9 vs. 29.0 ml/kg; BSA tertiles: 1,696 vs. 1,935 vs. 2,086 ml/1.73). In CAPD anuric patients VOLin prescription could be tailored to body mass to reach the minimum depuration target. Normalized VOLin might be prescribed in slightly higher doses (from 27 to 30 ml/kg exchange) for patients with higher body mass.