Simulating inadequate dialysis and its correction using an individualized patient-derived nomogram.

Optimization of the peritoneal dialysis prescription is dependent on proper characterization of the peritoneal membrane, as obtained by the peritoneal equilibration test (PET) or similar procedure. For any individual, certain predictions can be made to allow for decisions as to number of cycles, bag strength, and other options in order to maximize both small-solute clearance and ultrafiltration. In this paper, designed to address questions around correcting nonadherence to a prescribed peritoneal dialysis (PD) prescription, Lee et al. remind us that by using modeling programs, a series of theoretical prescriptions can be generated for each patient based on changes in cycle number or bag strength. From a selection of these prescriptions and using the current cycler technology that allows for downloading recent patient run data, and uploading new prescriptions, they demonstrate that one can correct for (scripted) nonadherent dialysis in relation to small-solute clearance. Currently, PD programs should be capable of making use of concepts from this study, as well as the ability to provide prescriptive changes via multiple preprogrammed memory cards or over modem/Internet, to provide patients with individually modeled and optimized options to correct certain forms of inadequate dialysis, for example, missed cycles or hours due to power failures.