Help me doctor, which renal replacement modality is best for me?

By W. Van Biesen

 

Figure 1

 

Patient is placed on a 4 x2litres/day CAPD regimen. Clinically, everything goes quite well but after 18 months of CAPD, a tendency for an increasing plasma creatinine and a hyperphosphataemia is observed. The patient has no uraemic symptoms, with good appetite, an active social life, and the studies are performed successfully.

A new evaluation of the peritoneal membrane is performed, using a PDC® test. The D/P creatinine ratio after 4 hours has decreased to 0.55, but there appears to be a high peritoneal permeability for large molecules. The residual clearance has deteriorated, and the patient is now almost in complete anuria.

 

Question 3