Volume Management With Peritoneal Dialysis

Fluid management in patients receiving peritoneal dialysis (PD) requires an understanding of the complex interplay between mechanisms of fluid accumulation, fluid shifts, and fluid removal. In this chapter, we will highlight the challenges in defining and establishing an “optimal volume status” in patients receiving PD, highlighting the role and interpretation of multiple physical exam findings, adjunct novel tools and technology, and clinical consequences of hypovolemia and hypervolemia. We will highlight the mechanisms that contribute to the development of fluid disorders in patients receiving PD and discuss nondialytic management that can facilitate the correction of volume disorders. Dialytic principles of sodium and water movement across the peritoneal membrane are reviewed and how these principles can be leveraged to enhance peritoneal sodium and fluid removal. These include optimization of the PD prescription, the role of PD modality, and the role of various and novel experimental PD solutions. Finally, the special clinical situations of the acutely volume overloaded patient and PD in the setting of anuria are discussed.