Getting Your Head Around The Handbook
The Handbook Of Peritoneal Dialysis Second Edition is a reference text you will find on the shelf of anyone who actually does PD long-term. It covers the clinical mechanics, the prescription adjustments, the complications you see in clinic, and the sort of procedural detail that matters when someone calls you at 2 AM because their effluent looks cloudy. The second edition updates are mostly around CAPD versus APD decision-making, recent ISPD guideline intersections, and expanded coverage on peritoneal membrane characterization and long-term modality failure. Most people use this book as a lookup resource rather than reading cover to cover. You pull it when a patient is underdialyzing despite adequate exchanges, or when a catheter keeps having outflow problems and you need to run through the troubleshooting matrix. The layout is section-based: anatomy and technique, dialysis adequacy targets, prescription parameters, infectious complications, mechanical complications, and then longer chapters on patient selection, transition from hemodialysis, and pediatric considerations. It's dense in places but not written for casual browsing. I kept one in the back room of our unit for about five years. The copies that survived the worst had dog-eared pages on the peritonitis management chapter and the part about dwell time calculations. Someone had also underlined a paragraph about high transporters being poorly served by long daytime dwells, which turned out to be correct more often than I liked to admit.
When It Actually Helps
The handbook shines when you need to reconcile prescription logic with real patient constraints. For example, a patient on CAPD who works nights and can only do three exchanges during the day ends up with a very different ultrafiltration profile than someone who stays home. The text walks through how to adjust dwell volumes and use icodextrin for the long dwell, which is exactly where most novices fumble. They leave the long daytime exchange with plain dialysate and then wonder why the patient gains weight despite "adequate" Kt/V numbers. Another area where this book is useful is the clear distinction between infectious and non-infectious causes of cloudy effluent. Exit-site infections, tunnel infections, and peritonitis all look similar at first glance. The handbook gives you a practical flow for swab cultures, Gram stain interpretation, and when to start empiric antibiotics before results return. It also covers what to do when your local resistance patterns make standard protocols less reliable.
Common Misreads And What To Do Instead
A frequent mistake is treating the adequacy targets as hard limits instead of thresholds. Kt/V and creatinine clearance numbers in the handbook are guidance ranges, not pass/fail cutoffs. A patient can hit the target on paper and still have troublesome fluid overload if their peritoneal solute transport is aggressive. High absorbers clear small solutes quickly but lose ultrafiltration capacity over longer dwells because glucose gets absorbed faster than water follows. Another misread is assuming that switching to APD automatically solves poor ultrafiltration. For a high transporter, nighttime cycler therapy can help by using shorter dwells and a morning icodextrin pause, but if the patient has marginal residual renal function, the cycler alone may not move enough fluid. In those cases, you need to combine strategy changes with dietary sodium restriction and sometimes a low-dose loop diuretic if the kidneys are still producing urine.
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A Specific Problem I Ran Into
I had a patient on CAPD whose prescribed regimen looked fine on paper. Three liters in the day dwells, one liter overnight, with dextrose 1.5 percent and 2.5 percent solutions. Their weekly Kt/V was acceptable, but they gained two kilograms between visits and had ankle edema. The handbook pointed me toward the transporter status chapter, so I requested a four-hour dwell with 2.5 percent dextrose and checked the effluent glucose recovery. The ratio came back above 0.80, confirming a high transporter pattern. The fix was straightforward once the physiology was clear. We switched the long daytime dwell to icodextrin 7.5 percent, kept the shorter dwells with low-dextrose solution, and added a night cycler schedule with a brief morning pause. Within two weeks, the patient's interdialytic weight gain dropped from about two kilograms to less than one kilogram. The handbook didn't give me the answer on its own, but it gave me the framework to stop chasing higher dextrose concentrations, which would have only worsened the membrane damage over time.
What The Book Does Not Cover Well
The second edition is not a substitute for the latest ISPD guidelines when those guidelines have moved forward on specific topics. Antimicrobial prophylaxis recommendations, catheter insertion techniques, and some of the newer data on biocompatible solutions get referenced but not always updated to the most recent consensus. If you are making institutional protocol changes based solely on this handbook, you should cross-check with current ISPD statements and local formulary availability. Another gap is practical supply and equipment guidance. The book discusses APD machines in principle but does not walk through troubleshooting alarm codes, cuff care in day-to-day use, or the sort of supply chain issues that arise when a particular solution concentration is backordered. For that, you are better off relying on your equipment vendor's clinical support team and the nursing protocols at your own unit.
How To Use This Resource Without Wasting Time
Start with the chapter that matches your immediate problem. If it is peritonitis, go straight to the microbiology and treatment sections before reading the introduction. If it is prescription adjustment, skip ahead to the adequacy and transporter chapters. The handbook is not designed for sequential reading, and trying to read it like a novel will make you miss the details you actually need. Keep a personal index of the most-referenced pages. In my copy, the peritonitis dosing tables, the dwell calculation examples, and the catheter malposition troubleshooting section were the only ones that stayed legible after repeated use. Photocopying or annotating those sections saves you from wearing out the binding while looking for the same information three months later.
Where To Find A Copy
The Handbook Of Peritoneal Dialysis Second Edition is available through major academic book retailers, medical supply bookshops, and library interloan systems. If you are buying for a clinic or training program, check whether the publisher offers an institutional discount or an e-book version, since the e-book tends to be more searchable when you need quick lookups during patient visits. Used copies circulate frequently in nephrology resale markets, but make sure the edition matches the one you need because pagination and some of the later chapters shift between printings. If you cannot locate a physical copy, many university libraries and large hospital systems keep one in their nephrology reference collection. You do not need to own it to use it effectively, provided you know which sections matter and how to find them quickly.
Bottom Line
This handbook is a practical clinical reference rather than a theoretical overview. It works best when you already have some hands-on exposure to PD patients and need to confirm prescription logic, interpret transporter results, or manage common complications. It is not comprehensive on supply logistics, and it does not replace current guideline documents for policy decisions. Use it as a troubleshooting companion, not a primary textbook, and it will save you time instead of adding to the stack of books on your desk.
