Measuring Compliance with Prescribed Exchanges in Capd and Ccpd Patients

Abstract

Objective To measure compliance with prescribed exchanges in continuous ambulatory peritoneal dialysis (CAPD) and continuous cycling peritoneal dialysis (CCPD) patients using inventories of home dialysis supplies; to determine the reliability of the ratio of measured to predicted creatinine (MIP) in predicting compliance with prescribed exchanges; to determine the effects of the ingestion of preformed creatine on the excretion of creatinine. Design A prospective analysis. Setting A university dialysis center. Patients Twenty patients on home peritoneal dialysis (PD). Measurements An inventory of supplies during two home visits over a 4 -8 week interval determined the number of PD exchanges performed. This number was divided by the number of exchanges prescribed for the period to determine the percent compliance. Three consecutive days of dialysate and urine were measured with all food consumed recorded during those days. MIP creatinine ratios and dietary protein intake (DPI) for each day were calculated. Results Of the patients tested, 8120 (40%) were found to be noncompliant with the prescribed number of exchanges based on the home visit inventories, performing a mean of 75% of their exchanges. There was no significant difference in the MIP creatinine ratios of compliant and noncompliant patients, nor were the MIP ratios distributed differently for compliant and noncompliant patients. The MIP ratios did not vary significantly over the 3 days. There was no correlation between the measured creatinine on a given day and the DPI for the same day. Conclusion Based on assessment of the patient's inventory, 40% of the patients studied were noncompliant with their prescribed exchanges, indicating this is a serious and common problem in PD patients. The MIP creatinine ratio is not a predictor of compliance in PD. We suggest the use of home visit inventories to assess compliance in PD patients.