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[Guidelines of the Italian Society of Nephrology. Peritoneal dialysis Guidelines].

The adequate dosage of peritoneal dialysis (PD) has been defined (using unrandomized and uncontrolled studies) asKt/V = 2, with a total (peritoneal + renal) creatinine clearance = 60 mL/min. The recent prospective, randomized ADEMEX study, suggests targets of 1.8 and 54 mL/min respectively. Dialysis must also be adequate to control fluid removal, phosphate levels, nutritional status, and hypertension. The targets for automated PD (APD) should be either 10% more than CAPD or similar, depending on the time of blood sample collection either immediately at the end of the automated exchanges or 6 to 8 hours after. A peritoneal equilibration test should be done 1 to 2 months after the start of PD, yearly, and when peritoneal permeability or ultrafiltration changes occurr. Residual renal function must be protected as long as possible by avoiding nephrotoxic drugs and excessive dehydration. Every effort must be taken in the attempt to maintain a good nutritional status and to diagnose as soon as possible any changes toward malnutrition. Hypertension has a high prevalence in PD patients and has negative effects on both cardiovascular status and patient survival. However, anti-hypertensive therapy should avoid hypotension, mainly in older patients, who are more at risk for cerebrovascular accident. Hyperparathiroidism must be controlled by diet, phosphate binders, and calcitriol supplement, but attention must be paid to avoid cardiac and vascular calcifications. Peritonitis and exit-site infection should be prevented by all means available. In the case of infection, empiric antibiotic therapy should be started as soon as possible and then adapted according to the antibiogram.

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