Low volume in UF


#1

Dear Dr
I have CKD from last 20 years. Got two renal transplant but it got failure. Now am in APD system from last 4 years. At initial stage my UF output was 2000 ml /10 HR of2.5%(10litres).Now it step by step reduced to 1500ml.
How to increase my UF


#2

While this is a PD question and is best dierected to our PD advisor, the slow reduction in and ultimate failure [insufficiency might be a beter word] of UF is the main technique-limiting factor in longer-term PD that ultimately leads to the failure of PD as an effective therapy.

Slowly, over time - luckily measured in years - there is a subtle change in the single cell layer of ‘mesothelial cells’ - the cells that line the peritoneal membrane - as they thicken and heap-up in a cobblestone pattern under the effect of AGE (Advanced Glycation End-products).

This ‘AGE’-ing process occurs as a result of the glucose that is used in PD fluid as a water-drawer (an osmotic agent), and it is sadly largely unpreventable, though some of the more physiological PD fluids (eg: Physioneal) or fluids like Icodextrin can help slow the process of UF failure.

UF failure is the commonest reason why PD, as a therapy, ultimately fails. We have, in the past, been too slow to recognise ‘membrane decline’. More recently, we have recognised our once-slow reaction time to UF failure and, instead of flogging PD to the point where symptoms of under-dialysis, malnutrion, a falling albumin, and general failure-to-thrive emerge, we have encouraged proactive steps to train home-adjusted PD patients into home HD when the signs of UF failure begin to be clear … thus transitioning from home PD to home HD as seamlessly as possible and avoiding centr-based care.

In the short term, increasing the concentration of your PD fluid will help increase your UF, but increasing the sugar content (concentration) also hastens membrane deterioration = a Catch-22.

You should discuss this with your home team, and formulate a step-wise plan to aid transition. They will help explain what I have outlined here more clearly. But … to be honest … UF failure is usually ‘the writing on the wall’ for the ultimate failure of PD as an effective dialysis modality … and early preparation for a replacement option - and we woukd suggest, here, home HD - is a crucial step that ought not be delayed.

This includes (especially) the early placement of an AVF so it is reafy, when needed, for (hopefully) home HD training … as I am afraid it will be.


#3

Dear sir
I had failure of AVF 8 times. In my both hands no vein for AVF. jugular also not working properly. One side femoral also used. That’s why am under PD. now for emergency I have only one femoral. What will do. Please give some suggestions.
Thank you
Suresh Kumar [quote=“Suresh_Kumar, post:1, topic:5548, full:true”]
Dear Dr
I have CKD from last 20 years. Got two renal transplant but it got failure. Now am in APD system from last 4 years. At initial stage my UF output was 2000 ml /10 HR of2.5%(10litres).Now it step by step reduced to 1500ml.
How to increase my UF
[/quote]


#4

Bump up the Solution Percentage from 2.5% to 4.25% If on a Cycler introduce the 4.25% as another bag. Anyways increase the solution percentage to increase the UF output.

Hope This Helps!


#5

mentioned above are good points.

Ask your home team of doctors, if they could repeat a PET test and evaluate if there is a change in your membrane transport status. membranes can be fast, slow, average transporters. Sometimes that can lead to a little tweaking to your prescription and help your UF again.

Yes increasing the glucose percentage will help the UF but as Dr. Agar notes, that is not advised long term as that will burn out the peritoneum long term.


#6

Thank you for your suggestion. I have done PET test it shows result as HIGH AVERAGE.
what will do the next


#7

Did your doctors feel they shud make a change to your prescription based on that information ? If no, why not ? If yes, what did they do ?

To increase your UF, one can increase your exchanges, decrease dwell time and still use 2.5 pe cent solutions.

For example if you are doing 4 exchanges 2 hours each for approximately 9 hours total ( works on a cycler) you can do 5 exchanges over the same time period , your uf shud increase . This is only an example . Your nephrologists shud be able to address his for you


#8

Doctor adviced me to do another two liter in day time. But that is not comfortable to me as a daily process.
Now am doing 5 cycles 10 1/2 hours1900 fill volume. shall I increased to 6 cycles


#9

I wouldn’t recommend doing anything without the support of your nephrologist as they know your history much better than I do.

However as an activist patient, you can ask your physician what effect increasing the cyclers exchanges would have on your UF rates which may challenge your medical team to address your concerns specifically.

hope this helps.


#10

I also wouldn’t recommend doing anything without the support of your nephrologist and team.

You can decrease the time frame associated in doing PD by running too strong of a solution and or too many treatments.

Over time your Peritoneal Lining will become less responsive to the treatments (PET) and your UF and Clearance will decrease as a result of this. In other words PD becomes ineffective permanently.

Hope this Helps!