PD Prescriptions for Diabetics
Start the PD modality based on kinetic modeling and patient’s preference.
After the first month of therapy obtain:
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24-Hour Batch_v2.pdf to assess delivered dose
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Clinical evaluation (hydration, nutrition, hypertension and glycemic control)
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Adjust prescription for inadequate UF by:
– Increasing the number of exchanges or reducing dwell time
– Avoid prolonged exchanges
– Consider NIPD if adequacy criteria are fulfilled
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Adjust prescription for inadequate dose by:
– Increasing exchange volume (Vip) as tolerated
– Increase total dialysate volume and dialysis flow rate (DFR)
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Adjust insulin according to glycemic control:
– Increase dose of divided SQ insulin, insulin pump or IP insulin
– Try to lower the glucose concentration by reducing dietary sodium and fluid intake,
improving glucose control, use of more frequent and shorter dialysis exchanges and
encourage regular exercise
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Adjustments according to nutritional status:
– Dietary counseling
– Oral nutritional supplements