CAPD: How safe is it to use 4.25% solution?

[kickingandscreaming]

Lately, I have had a couple of instances where I needed to use 4.25% to get off some fluids--quickly. Usually, I am not a good producer of UF.  I am getting good solute clearance, but not a lot of fluid comes off when I use 1.5 or 2.5. Usually I'm not very fluidy.  I think I'm a fast transporter, but I have yet to do a PET, so I'm just guessing about that.  I have read that 4.25 is a culprit in wrecking the peritoneum over time.  I am trying NOT to use it, but clearly it is needed at times.  What are your thoughts on this?

[Charlie B53]

No experience.  I've used the 4/5% only once.

I was taught during training that the higher concentration of sugar in the 4 1/2% mixture does contribute to an earlier failure of the membrane to function.

Cannot tell high soon that would be as everyone is a bit different.

Wondering more why the need?  Are you fluid restricted or the better question may be, SHOULD you be?  Wet foods does contribute so much more fluid, as well as hidden salts driving us to thirst, conspire to increase the water loading and increase demand for dialysis removal.

I try to balance my thirst a bit, watching my weight day/night and have been fortunate so far to be successful in using a 50/50  yellow/green.  One bag each on my Cycler, plus my Ico.

[amanda100wilson]

A big decider of whether you need to do stronger bags, comes down to fluid intake and residual  function.  Once the latter is lot, it becomes much harder to get adequate fluid off with lower strength bags.  this was true for me.  I did PD for eight years.  it went fine for about four, and then I lost my residual function.  over the next four years I want from all yellow, to two yellow and one green, then one yellow and two green, then all green, then two green, one red, then two red,
 one green, then by the end all red.  of course this was not an absolute but the general pattern.  I was also prescribed icodextrin (extraneal) for day dwells,  which pulls fluid more slowly and prevented re-absorption during the long day dwell, as my transportation rate went from low average to a fast transporter.  my adequacy tests were not affected until the end of my time on PD.  This, unfortunately, is the pattern of PD, and although some people manage to do PD for many years, the risk of developing EPS (encapsulating peritoneal sclerosis), a rare but also devastating and usually fatal complication also increases. 

as to whether to use red bags?  in my opinion it is an expected progression, unless you severely limit your fluid intake.  you essentially do what you have to do.  I attended a conference, where the nephrologist described this exact progression, so I don't think my experience is unique.  I now do home hemo., with a NxStage machine for the past 4 years, and feel so much better than those last four years on PD.

[kickingandscreaming]

Thank you, Amanda, for this unvarnished view of long-term PD.  Everyone is so chipper about it and "pretends" that it can go on forever.  This is why the term "PD first" is so telling.  "First" implies that there is a second that is inevitable--whether it's clinic HD or HHD or transplant.  Or hospice. 

Is there any way to preserve residual function?  That seems to be the key.

[Simon Dog]

Is there any way to preserve residual function?  That seems to be the key.

Use PD instead of HD and start dialysis earlier in the renal failure cycle.

[kickingandscreaming]

Use PD instead of HD and start dialysis earlier in the renal failure cycle.

Too bad.  I guess it's too late.  I did start  with PD (except for the 2 months of urgent hemo I had to do), but I started D pretty late in the failure cycle @6%.  I still have RRF, but I wish there were a way to preserve what I have for longer.

[Charlie B53]

My Neph and Dialysis Team made it clear from the beginning that PD can last for many years for SOME patients.  But then again for MOST patients PD will eventually fail to provide adequate clearance and then hemo WILL BE REQUIRED.

There is NO WAY to predict how long PD will be effective for anyone.

I went ahead with PD as it is easy, and I won't have to face my needle-phobia for hopefully a very long time.

Keeping my fingers crossed, watch what I eat and drink far better than I used to.

Seldom eat much 'junk'.  Drink water.