Careful patient selection and dialysis prescription are required for effective nightly intermittent peritoneal dialysis

Objective: To evaluate the adequacy of dialysis in patients on nighttime intermittent peritoneal dialysis (NIPD). Design: Retrospective review of prospectively collected data. Patients: Seven patients on NIPD. Measurements: The fast peritoneal equilibration test (PET) was used to determine peritoneal membrane permeability for small solutes. Adequacy of dialysis measured by 24-hour collections of dialysate and urine for weekly KT/V and clearance in liters/week/1.73 m² was assessed in patients with (n = 3) and without (n = 4) residual renal function and evaluated in concert with the patients clinical status. Outcome for each patient was also noted. Results: Five of the patients had a high-average dialysate/serum creatinine by PET (> 0.66). Despite a weekly KT/V of 1.7 or more, four of the seven patients on NIPD were uremic and either transferred to hemodialysis or continuous cycling peritoneal dialysis (CCPD). A fifth patient had a KT/V of 1.4 and was also uremic on NIPD. The patient who was clinically well and continued on NIPD had significant residual renal function. Conclusions: NIPD should be restricted to patients with high-average dialysate/serum creatinine as determined by PET and residual renal function or those with high dialysate/serum creatinine. Extended dialysis time and large volumes of dialysate are required for successful NIPD in patients without residual renal function. Accepted parameters of dialysis adequacy used for patients on continuous peritoneal dialysis are not appropriate for intermittent forms of peritoneal dialysis.