Current approaches to prescription and optimization of peritoneal dialysis: a practical review

Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine

Abstract Peritoneal dialysis (PD) is an established form of kidney replacement therapy that offers patients the possibility of homebased treatment with significant flexibility and autonomy. Despite its advantages, many physicians in training and those just starting their clinical practice feel uncertain when prescribing PD, given the technical aspects, individualized adjustments, and the variety of modalities available. This manuscript provides a practical and didactic overview of how to prescribe PD, focusing on both continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). The discussion begins with the fundamental principles of solute and fluid transport, followed by step-by-step guidance on prescription elements such as dialysate volume, dwell time, number of exchanges, glucose concentration, and the use of icodextrin. Special attention is given to differences between CAPD and APD, highlighting the strengths and limitations of each approach in terms of clearance, ultrafiltration, and patient lifestyle. By combining theoretical background with clinical examples, this teaching resource aims to bridge the gap between guideline recommendations and bedside practice. Ultimately, the article seeks to empower clinicians to prescribe PD with confidence, improve patient-centered decision-making, and foster broader adoption of this therapy, which remains underutilized despite its well-documented clinical and social benefits.