PD Prescriptions for Diabetics

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Start the PD modality based on kinetic modeling and patient’s preference.  After the first month of therapy obtain:

• PET
• 24 hr dialysate collection to assess delivered dose
• Clinical evaluation (hydration, nutrition, hypertension and glycemic control)
• Adjust prescription for inadequate UF by:

                     -  Increasing the number of exchanges or reducing dwell time

                     -  Avoid prolonged exchanges

                     -  Consider NIPD if adequacy criteria are fulfilled

• Adjust prescription for inadequate dose by:

                     -  Increasing exchange volume (Vip) as tolerated

                     -  Increase total dialysate volume and dialysis flow rate (DFR)

• Adjust insulin according to glycemic control:

                     -  Increase dose of divided SQ insulin, insulin pump or IP insulin

                     -  Try to lower the glucose concentration by reducing dietary sodium and fluid intake,

                         improving glucose control, use of more frequent and shorter dialysis exchanges and

                         encourage regular exercise

• Adjustments according to nutritional status:

                     -  Dietary counseling

                     -  Oral nutritional supplements

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