Quality of Life Clinical Trial
Official title:
Designer Dialysis: Designing a Peritoneal Dialysis Prescription That Fits a Patient's Lifestyle
This study aims to use modified peritoneal dialysis prescriptions to achieve adequate clearance and volume removal while decreasing the number of exchanges or time spent on dialysis, evaluating maintenance of residual renal function, and improving quality of life.
Patient's currently on peritoneal dialysis at our program can be considered for this study.
In order to be enrolled, patients patient's must have significant residual renal function
defined as a renal Kt/V >1.0. These patients will then be consented, and if agreeable, the
participant's dialysis prescriptions will be modified to decrease their peritoneal dialysis.
For patients on continuous ambulatory peritoneal dialysis (CAPD), this may mean less
exchanges in a 24 hour period, or less exchanges over the course of the week (does not need
to perform exchanges every day). Patients who are continuous cycler peritoneal dialysis
(CCPD) will be modified to shorter cycler times, or also less cycles during the course of
the week (does not need cycler therapy every day).
Patients will need to continue achieving adequate weekly total Kt/V of greater than or equal
to 1.7 as per national recommendations and the clinical guidelines within our unit. This is
calculated using the residual renal (RR) Kt/v and the PD Kt/V. Patients will also perform
monthly 24 hour urine collections for urinary volume, creatinine clearance, and urea
clearance. Adequacy is typically measured every 3 months based on our internal lab
requirements, but patients will need to perform adequacy measurements any time their
prescription is changed. The investigators will measure monthly labs per routine including
albumin, parathyroid hormone (PTH), serum phosphorus, and hemoglobin.
The investigators hypothesize that patients will have a better quality of life (QoL) while
on a modified dialysis prescription with less exchanges or less cycler time as assessed by
the kidney disease quality of life (KDQOL-36) survey tool. The investigators believe that
patients with higher levels of residual renal function (≥ 2 mL/min) can perform fewer
peritoneal dialysis exchanges while still achieving and maintaining adequate clearance of
solute and appropriate volume removal. The investigators also believe that by maximizing the
use of the residual renal function, the investigators can adjust the peritoneal dialysis
prescription by decreasing the numbers of manual exchanges per day, decreasing cycler time,
or possibly decreasing the number of days of dialysis each week. With the benefit of less
dialysis time or exchanges per day, the investigators believe patients will have a decreased
"burnout" rate by allowing them to have a better QoL and not feel burdened by the dialysis
therapy.
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