Which dialysate is preferred for long dwells in high transporter PD patients to improve ultrafiltration?

Which dialysate is preferred for long dwells in high transporter PD patients to improve ultrafiltration?

• A. Normal saline.
• B. Icodextrin.
• C. Dextrose.
• D. Lactated Ringer's.

Answer: (B)

For long dwells in high transporter PD patients, preserving ultrafiltration over several hours is key. Icodextrin works here because it’s a glucose polymer that stays in the peritoneal cavity longer and creates a sustained colloid osmotic gradient. This keeps pulling water across the membrane throughout a long dwell, counteracting the rapid decline in ultrafiltration you’d see with glucose-based solutions in high transporters. Normal saline has no osmotic effect to drive ultrafiltration, so it wouldn’t improve UF. Dextrose can provide ultrafiltration but is quickly absorbed, so its effect diminishes during a long dwell. Lactated Ringer’s isn’t used for PD and would introduce electrolytes that aren’t intended for PD exchanges, without delivering sustained UF.

For long dwells in high transporter PD patients, preserving ultrafiltration over several hours is key. Icodextrin works here because it’s a glucose polymer that stays in the peritoneal cavity longer and creates a sustained colloid osmotic gradient. This keeps pulling water across the membrane throughout a long dwell, counteracting the rapid decline in ultrafiltration you’d see with glucose-based solutions in high transporters.

Normal saline has no osmotic effect to drive ultrafiltration, so it wouldn’t improve UF. Dextrose can provide ultrafiltration but is quickly absorbed, so its effect diminishes during a long dwell. Lactated Ringer’s isn’t used for PD and would introduce electrolytes that aren’t intended for PD exchanges, without delivering sustained UF.