As the population of
chronic kidney disease (CKD) and
end-stage renal disease (
ESRD) grows at an alarming rate, primary care physicians will increasingly be involved in the management of these patients. Early recognition of CKD and timely referral to a nephrologist when glomerular filtration rate approaches 30 mL/min/1.73 m(2) is extremely important to improve
ESRD outcome and appropriate selection of dialysis modality.
Peritoneal dialysis (PD) remains a viable treatment option for
ESRD patients. PD is less expensive dialysis modality and may provide a survival advantages over
hemodialysis in first 2 to 4 years of treatment. Preserving residual renal function (RRF) is of paramount importance to prolong the survival outcomes in PD patients. Thus preservation of RRF is an important goal in the management of PD patients. Every effort should be made to avoid nephrotoxic drugs like
aminoglycosides and nonsteroidal anti-inflammatory drugs, and limit the use of
radiocontrast agents in PD patients with RRF. Judicious use of prophylactic
antibiotics to prevent
peritonitis would further help to reduce morbidity from PD. Protecting peritoneal membrane from long-term toxic and metabolic effects of the conventional
glucose-based solutions is another objective to further improve PD outcome. Development of new, more biocompatible PD solutions holds promise for the future. One such
solution,
icodextrin, is now approved for use in the United States. Although extremely safe to use, it is associated with unique metabolic effects that may concern primary care physicians. They include false elevation of
blood glucose, a reversible increase in serum
alkaline phosphatase and a false decline in serum
amylase. Monitoring of glycemia by assays that use
glucose dehydrogenase pyrroloquinoline quinone enzymes should be avoided and serum
amylase alone should not be relied on in diagnosing
pancreatitis in patients on
icodextrin.