Total cycler treatment time should be guided by the patient's typical duration of sleep.
We recommend a maximum of five overnight cycles in a 9-hour period in a high/high-average transporter and four cycles in a low/low-average transporter. Furthermore, the time to fill and drain each exchange can take 15 minutes each, longer with constipation and PD catheter dysfunction. With excessively short APD dwell times, there is a greater risk of sodium sieving, particularly with hypertonic solutions. The clinical consequence may be hypernatremia, which may stimulate thirst, potentially exacerbating hypervolemia. Early in the dwell, aquaporin relative to small pore water movement is greatest, potentially leading to more free-water transport compared with sodium-coupled water transport, a phenomenon called sodium sieving. With dextrose-based solutions, small pores and water-selective aquaporins participate in water removal, whereas sodium moves only across small pores. Maximum UF is typically 330☑☒58 ml for a 1.5% and 4.25% dextrose solution, respectively ( 5). UF increases with increasing dextrose concentration because of the greater osmotic gradient. On average, maximal UF usually occurs after 140 minutes with 1.5% dextrose and 247 minutes with 4.25% dextrose ( 5).
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