The following is an adaptation of the executive summary of the Canadian Society of Nephrology Clinical Practice Guidelines and Recommendations on Peritoneal Dialysis Adequacy 2011 . The original document can accessed separetely at this link. Please feel free to comment on these guidelines in the form below
The original summary is provided by:
Peter G. Blake,1 Joanne M. Bargman,2 K. Scott Brimble,3 Sara N. Davison,4 David Hirsch,5 Brendan B. McCormick,6 Rita S. Suri,1 Paul Taylor,7 Nadia Zalunardo,7 and Marcello Tonelli,4 the Canadian Society of Nephrology Work Group on Adequacy of Peritoneal Dialysis
1Division of Nephrology, University of Western Ontario, London, Ontario; 2Division of Nephrology, University of Toronto, Toronto, Ontario; 3Division of Nephrology, McMaster University, Hamilton, Ontario; 4Division of Nephrology and Transplant Immunology, University of Alberta, Edmonton, Alberta; 5Division of Nephrology, Dalhousie University, Halifax, Nova Scotia; 6Division of Nephrology, University of Ottawa, Ottawa, Ontario; 7Division of Nephrology, University of British Columbia, Vancouver, British Columbia, Canada
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1.1 MEASUREMENT OF RRF
1.1.1 Residual renal urine volume and residual renal Kt/V (rKt/V) should be measured every 3–6 months in patients with a peritoneal Kt/V (pKt/V) of less than 1.7 weekly, especially if RRF is rapidly declining. In all other PD patients, rKt/V and urinary volume should be measured together with pKt/V when clinically indicated (see Recommendation 2.1.5) (grade D, opinion).
1.1.2 It may help clinical understanding use a mean of 24-hour urine urea and creatinine clearance to express RRF as a glomerular filtration rate (GFR) in milliliters per minute (grade D, opinion).
1.2 USE OF ANTIHYPERTENSIVE AGENTS AND DIURETICS TO PRESERVE RRF
1.2.1 Per recommendations by the Canadian Hypertension Education Program (CHEP), BP should be controlled to less than 130/80 mmHg provided that this is not associated with signs and symptoms of postural hypotension or volume depletion (grade D, opinion).
1.2.2 Angiotensin converting-enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs) should be strongly considered, unless contraindicated, in all PD patients with significant (>100 mL daily) urine output (grade B).
1.2.3 Strong consideration should be given to the use of high-dose oral furosemide (up to 250 mg daily) and oral metolazone (up to 5 mg daily) in all PD patients with significant (>100 mL daily) urine output, provided that this is not associated with signs and symptoms of postural hypotension or volume depletion (grade B).