Posology : מינונים

4.2       Posology and method of administration
Posology
CAPD 17/18/19 is exclusively indicated for intraperitoneal use.
The mode of therapy, frequency of administration, and dwell time required will be specified by the attending physician.

Continuous ambulatory peritoneal dialysis (CAPD)
Adults:
Unless otherwise prescribed, patients will receive an infusion of 2000 ml solution per exchange four times a day. After a dwell time between 2 and 10 hours the solution will be drained.

Adjustment of dosage, volume and number of exchanges will be necessary for individual patients.

If dilation pain occurs at the commencement of peritoneal dialysis treatment, the solution volume per exchange should be temporarily reduced to 500-1500 ml.

In large patients and if residual renal function is lost, an increased volume of dialysis solution will be necessary. In these patients, or patients who tolerate larger volumes, a dose of 2500 – 3000 ml solution per exchange may be given.

Paediatric population:
In children the solution volume per exchange should be prescribed according to age and body surface area (BSA).

For initial prescription, the volume per exchange should be 600-800 ml/m2 BSA with 4 (sometimes 3 or 5) exchanges per day. It can be increased up to 1000-1200 ml/m2 BSA depending on tolerance, age and residual renal function.

Automated peritoneal dialysis (APD)
If a machine (sleep•safe cycler) is used for intermittent or continuous cyclic peritoneal dialysis, larger volume bags (e.g. 5000 ml) providing more than one solution exchanges are used. The cycler performs the solution exchanges according to the medical prescription stored in the cycler.

Adults:
Typically patients spend 8-10 hours a night cycling. Dwell volumes range from 1500 to 3000 ml and the number of cycles usually varies from 3 to 10 per night. The amount of fluid used is typically between 10 and 18 l but can range from 6 to 30 l. The cycler therapy at night is usually combined with 1 or 2 exchanges during the daytime.

Paediatric population:
The volume per exchange should be 800-1000 ml/m2 BSA with 5-10 exchanges overnight. It can be increased up to 1400 ml/m2 BSA depending on tolerance, age and residual renal function.

There are no special dosage recommendations for elderly patients.

Peritoneal dialysis is a long term therapy involving repeated administrations of single solutions.
Method and duration of administration
Patients must be trained appropriately, must practise the technique and be shown to be proficient at performing peritoneal dialysis before performing it at home. The training should be performed by qualified personnel. The attending physician must ensure that the patient masters the handling techniques sufficiently before the patient performs peritoneal dialysis at home. In case of any problems or uncertainty the attending physician should be contacted.

Dialysis using the prescribed doses should be performed daily and should be continued for as long as renal function substitution therapy is required.

Continuous ambulatory peritoneal dialysis (CAPD): stay•safe bag
The solution bag is first warmed to body temperature. For details see 6.6.
The appropriate dose is infused in the peritoneal cavity using a peritoneal catheter over 5 - 20 minutes. Depending on physician's instructions, the dose should dwell in the peritoneal cavity for 2 - 10 hours (equilibrium time), and then be drained.
Automated peritoneal dialysis (APD): sleep•safe bag
The connectors of the prescribed sleep•safe solution bags are inserted in the free sleep safe tray ports and then automatically connected to the sleep•safe tubing set by the cycler. The cycler checks the bar codes of the solution bags and gives an alarm when the bags do not comply with the prescription stored in the cycler. After this check the tubing set can be connected to the patient’s catheter extension and the treatment be started. The sleep•safe solution is automatically warmed up to body temperature by the sleep•safe cycler during the inflow into the abdominal cavity. Dwell times and selection of glucose concentrations are carried out according to the medical prescription stored in the cycler (for more details please refer to the operating instructions of the sleep•safe cycler).

Depending on the required           Depending on the required          Depending on the required osmotic pressure, CAPD 17 can       osmotic pressure, CAPD 18 can      osmotic pressure, CAPD 19 can be used sequentially with other     be used sequentially with other    be used sequentially with other peritoneal dialysis solutions       peritoneal dialysis solutions      peritoneal dialysis solutions with higher glucose content (i.e.   with lower glucose content (i.e.   with higher or lower glucose with higher osmolarity).            with lower osmolarity).            content (i.e. with higher or lower osmolarity).