A: Your Nephrologist will ultimately determine how many exchanges you will need to perform initially and ongoing to ensure you receive enough dialysis. You may start off on one prescription and as your kidney function changes the prescription will be adjusted to keep you in optimal health while on PD. It is important to remember that your native kidneys typically perform their function continuously. In order to mimic that cleansing, enough dialysis must be performed to avoid uremic symptoms such as nausea, vomiting, itching and restless legs. If you still make urine you may not need as much dialysis initially, but as your urine production decreases, which can be determine by adequacy testing, the Nephrologist will need to make adjustments to your prescription to address the decline. If you are brand new to dialysis and PD is your first modality you may have periods during day or night when you do not have any dialysate in your peritoneum, sometimes referred to as a "dry period". You may also start off with less than 4 exchanges per day but those prescribing decisions will be determined by your Nephrologist and will be based on your individual clinical needs. Thank you for the great question.
Michelle Cassin RN CPDN
Sr. Clinical Director