Table 6.

Phases of an integrated home dialysis model that uses peritoneal dialysis as the first modality

Early Response PhaseIntermediate Response PhaseTransition Point Phase
“No-harm” prescriptionDecreasing residual renal functionUrine volume <250 ml/d with progressive LV hypertrophy
Preserve residual renal functionIncreasing serum phosphorusPhosphorus >6.0 mg/d or uncontrolled SHPT
Optimize volume controlEdemaUltrafiltration failure
Control BPPoorly controlled BPUncontrolled hypertension, with BP >150/90 mm Hg
Achieve nutritional balanceWorsening LV hypertrophy, per echocardiogramLoss in lean body mass
Design care to avoid hospitalizationsGradual decrease in functional statusWeight gain >15 kg
More than one episode of peritonitis during the first yearUncontrolled hyperglycemia and/or HbA1c >7%
Hospitalization rate >1.5 admissions per yearRecurrent peritonitis during the first year
Total Kt/V <1.7Total Kt/V <1.7, despite multiple prescription changes
  • In the early response phase, patients are generally stable and only minor adjustments to the peritoneal dialysis prescription are needed to achieve listed medical goals. In the intermediate response phase, listed signs of clinical deterioration may require more substantial changes to the peritoneal dialysis prescription and may signal an approaching transition to home hemodialysis. Finally, in the transition phase, serious adverse events signal an imminent need for transition to home hemodialysis. LV, left ventricular; SHPT, secondary hyperparathyroidism; HbA1c, hemoglobin A1c.