Version July 2025
| Week 1 |
| Monitor serum electrolytes and volume and acid-base status daily. |
| Hold PD for 2 to 3 days (if dialysis is needed sooner, temporary HD may be necessary). |
| Resume PD in the supine position with 50% volume per exchange of home prescription (maximum 1 L each exchange); 2 to 3 exchanges over 10 hours with no last fill.Δ No last fill allows time for ambulation and physical therapy. |
| Week 2 |
| Evaluate the necessity of supine-only PD (depends on abdominal wall wound healing/integrity). |
| Increase the PD prescription to 75% volume per exchange of home prescription (maximum 1.5 L each exchange); 2 to 3 exchanges over 10 hoursΔ with 500 to 750 mL last fill. |
| If leak present, hold PD for 1 to 2 days and then resume week 1 PD prescription. After 4 to 5 days, restart week 2 PD prescription. Persistent leaks require at least a temporary switch from PD to HD. |
| After 7 days without leaks on the week 2 prescription, resume home PD prescription. |
PD: peritoneal dialysis; HD: hemodialysis.
* Less dialysis may be needed for patients with greater residual kidney function.
¶ This approach also applies for cardiothoracic surgeries with suspected or known violation of the peritoneal cavity, unless a pleuroperitoneal dialysate leak is present. Patients with a postoperative pleuroperitoneal dialysate leak require at least a temporary switch from PD to a different modality of kidney replacement therapy.
Δ If longer dwell times (eg, 3 to 4 hours per dwell) lead to reabsorption (ie, negative ultrafiltration), the number of exchanges over 10 hours may be increased.