Extraneal and clearance concerns

Ask Our Experts Dr. Shree Mulay and Josh Dipzinski, PD Experts
1

After discussions with you I requested to start using extra and have recently started using it to help save my membrane vs in the past using high dextrose level fluid. Thank you for your advice and guidance.

I have another question. I have started using extraneal as my long dwell . I went on a two day trip and used manual only and still used extra as my long dwell and did not do the recommended number of exchanges. The next day I had to bring in a sample for testing after using the cycler and extra as my long dwell. That test came back less than 1.7 and I am concerned. The last one I did with dextrose and a day time exchange hit 2.3 but usually I am on or near 1.7. That 2.3 result was with another day time exchange and some urine output. My practice until I started extraneal was to do a day timne exchange or even two, but my PD nurse wanted to see what it would be with just the cycler Extra as my last fill and no day time exchange. I had some fibrin and used Hep, but have not seen fibrin since using the extraneal. In the past I had to use red to get enough fluid out usually using red a couple of times a week. My BP is ok and fluid retention is ok and my weight is and has been about 265lbs. Other blood chems are ok and my potassium and phos is a little high and a challenge for me. my weight had hit 293 and I have lost down and keep down to 270 or less after starting PD. I do not want to ever do HD if I can avoid it and worry about my clearance.

My question is I want to use extraneal to save my membrance and could I do a day time exchange after several to 8 hours and put it green or even another extra before starting my night time exchange to hit 1.7 or higher number? The fact that extar exchnages yielded 2.3 should mean my PD will work given the right combination and number of exchanges, right? My other test on membrane showed my absorbsion rate was medium and unchanged since I started PD a couple of years ago. AS I had to use red a few times a week to get higher UF, aren’t I better off using more extraneal and not using the high dextrose red?
I am eating and feeling ok, so are these numbers absolute or does how you are doing come into play?

2

Well first, it was probably not a good idea to do a 24 hour clearance study the day after you had been on a different prescription (CAPD) and not even doing all of those exchanges. You need to be on your regular prescription again for several days to “equilibrate” and then get the samples. Has your urine output gone down? and is the clearance of urea and creatinine less in your urine than before? Are you on a diuretic (like lasix)? This will help your kidney’s clear more fluid each day, so you may want to ask the nephrologist about a diuretic. And are you restricting your salt and fluid intake as prescribed? Remember that you can help not have so much fluid in your body needing to be removed if salt and liquids are restricted. Perhaps some increase in prescription may be needed, but the target is 1.7 or higher. And the goal is to have you eating and feeling OK, which you say you are, so yes, the numbers are not absolutes. It is good to hear that your membrane absorption rate has not changed since you began PD. It is definitely not good to add high dextrose red. Avoid it as much as possible. Draining extraneal after 8 hours and doing another high dextrose exchange is not recommended. Extraneal is designed to continue a slow and steady ultrafiltration for up to 11 hours. Adding another high dextrose exchange would simply add more calories and expose the membrane to more dextrose, both thingds you want to avoid.
Hope this information helps.
Judy Bernardini

3

Dear J Bernardini,

What about a lower dextrose . e.g. green after 8 hours?

My urea did go down, out put of urine was done a bit, so I understand about the lasix. I will do a better job on salt intake. As you pointed out, I will repeat the test after several days of using the cycler and the long dwell extraneal, as prescribed. Hopefully the number will go up too.

You are right, as I feel good, eating well, too well at times and had a reduced urea number. It must be helping.

Thank you for your advice.

Steve