The Principles of Drug Dosing in Peritoneal Dialysis

The prevalence of chronic kidney disease (CKD) is significantly increasing, impacting approximately 23 million Americans. Greater than 660,000 have end-stage kidney disease (ESKD) requiring dialysis. It is estimated that in the United States, only approximately 10% of patients with ESKD receive peritoneal dialysis as kidney replacement therapy. In comparison, the utilization of PD is much higher in other countries. The latest estimate indicates that over 270,000 patients are receiving peritoneal dialysis worldwide accounting for 11% of all the kidney replacement modalities. Peritoneal dialysis patients are at increased risk for infections, cardiovascular complications, anemia, and adverse drug reactions, all of which contribute to the greater morbidity and mortality compared to both the general population and CKD I–III patients. Polypharmacy is a common problem in patients with end-stage kidney disease; work from a cross-sectional study in the province of Ontario, Canada, has established that end-stage kidney patients take, on average, 12 ± 5 distinct medications per day (about 19 pills daily), with 70% reported potentially inappropriate.