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| Strategies | Practice |
|
| (1) Opportune nephrology referral | More than 3 months before dialysis initiation, ideally when GFR ≤ 30 mL/min |
| (2) Residual renal function protection | Avoidance of dye studies, nonsteroidal antiinflammatory drugs (including cyclooxygenase-2 inhibitors), aminoglycosides, and extracellular fluid depletion |
| (3) Control of cardiovascular risk factors | Diet counseling and promotion of physical activity to avoid obesity; pharmacologic therapy for hypertension atherogenic dyslipidemia, dysglycemia and prothrombotic state (ACE inhibitors, AII receptor antagonists, B blockers, statins, and aspirin) |
| (4) Patient education and multidisciplinary support | Group discussion and individual consultation (booklets, video, and interview) promotion of hometherapy and transplantation (both renal and renopancreatic) glycemic control optimization foot care and peripheral vascular evaluation ophthalmologist followup |
| PD specific strategies | |
| (5) Skilled volume evaluation and control | Panel of clinical evaluation (blood pressure, weight, and edemas), biomarker (pro BNP) and multifrequency BIA (longitudinal trends of body composition) high-dose furosemide fluid, and sodium restriction elective use of icodextrine and APD |
| (6) Preferential use of low GDP solutions, glucose sparing regimens, and individualized low calcium solutions | Avoidance of hypertonic bags use Bi/tri compartment bag solutions (low GDP) individualized low Ca solutions prescription “PEN” regimen: physioneal; extraneal; dianeal; “NEPP” regimen: 1 amino acid exchange, 1 icodextrin exchange, and 2 glucose bicarbonate/lactate exchanges as options |
| (7) Nutritional evaluation and support | Assessed by a panel: subjective global assessment (SGA), protein equivalent of nitrogen appearance (nPNA), serum albumin and lipid profile, multifrequency BIA diet counseling by nutritionist |
| Enteric supplements (protifar as protein supplement) peritoneal supplement (nutrineal once day) |
| (8) Preferential use of RAAS acting drugs | ACEI and ARB as first antihypertensive drugs possible protective effects in peritoneal membrane status |
| (9) Optimize technique survival and opportune transfer to HD | International recommendations on peritoneal access management and prophylactic measures individualized training and retraining peritonitis rate systematic control and quality assessment individualized APD prescription depression assessment and specific management routine annual peritoneal membrane evaluation |
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