We performed the present study to determine dialysis adequacy targets for improved clinical outcome in elderly chronic peritoneal dialysis (PD) patients. Since 1993, 19 elderly patients (14 men, 5 women; 5 with diabetes, 14 without diabetes; mean age: 78.9 +/- 7.0 years; median time on PD: 47.7 months) at our center have been treated mainly with automated PD. Using the PD-NAVI software (JMS, Hiroshima, Japan), we measured the patients' peritoneal equilibration test (PET), Kt/V urea (Kt/V), creatinine clearance (CCr), and ultrafiltration (UF). The nutrition status of the patients was estimated by subjective global assessment (SGA), percentage creatinine generation rate (%CrGR), serum albumin, and ratio of extracellular fluid to total body water (ECF.TBW). For these patients, we particularly focused on reducing intra-abdominal pressure in the daytime. Despite lesser dwell volumes in the daytime, optimal prescriptions were reached by using the PD-NAVI simulation software to increase the nightly volume. All patients showed good SGA grades (A and B) with the modified prescriptions developed using PD-NAVI. Dialysis dose and nutrition parameters were as follows: dwell volume, 8.2 +/- 1.6 L/day; weekly Kt/V, 2.12 +/- 0.3; weekly CCr, 61.9 +/- 9.1 L; total UF, 891 +/- 157 mL/day; %CrGR, 119.1% +/- 18.4%; serum albumin, 3.5 +/- 0.3 g/dL; and ECF:TBW, 0.364 +/- 0.01. Overall patient survival was 82% at 135 months. Prescriptions for chronic PD that achieve adequate solute removal and sufficient UF, produce good clinical outcomes and good nutrition status in elderly patients.
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