SP690HOME HEMODIALYSIS (HHD) WITH LOW DIALYSATE VOLUME (LDV) - THE GREEN BENEFITS

Objectives To determine the effect of changing dialysate volume on urea and glucoseequilibration curves and to determine, if dialysate volume is prescribed on the basis of body surface area, whether equilibration curves will be consistent in patients of different sizes and ages. Design A prospective study wherein children with acute or chronic renal failure had peritoneal equilibration studies done with dwell volumes of 30 mL/kg, 40 mL/kg, and 1200 mL/m2. Patient Population Twenty-two children: 7 under 3 years of age; 8 between 3 and 10 years of age; 7 older than 10 years of age. Statistics Student's t-test. Results Urea and glucose equilibrated rapidly at dwell volumes of 30 mL/kg, slower at dwell volumes of 40 mL/kg, and slowest at dwell volumes of 1200 mL/m2. Equilibration curves were similar in children of different ages when dialysate volumes of 1200 mL/m2 were infused. Conclusion Dialysate volumes of 1200 mL/m2 should be used when equilibration studies are being done to compare individuals of different ages and sizes.

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Peritoneal Solute Clearances after four Years of Continuous Ambulatory Peritoneal Dialysis (CAPD)

Peritoneal Dialysis International ◽

10.1177/089686088900900116 ◽

1989 ◽

Vol 9 (1) ◽

pp. 75-78 ◽

Cited By ~ 19

Author(s):

Min Sun Park ◽

Jean Lee ◽

Moon Sung Lee ◽

Seung Ho Baick ◽

Seung Duk Hwang ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Continuous Ambulatory Peritoneal Dialysis ◽

Glucose Absorption ◽

Peritoneal Membrane ◽

Vasoactive Agents ◽

Membrane Function ◽

Dialysis Solution ◽

Before And After ◽

Dialysate Volume

In order to evaluate peritoneal membrane function and responsiveness of peritoneal microcirculation to vasoactive agents in long-term continuous ambulatory peritoneal dialysis (CAPD) patients, we studied peritoneal clearances of urea (Curea) and creatinine (Ccr), protein concentrations in drained dialysate (D PC), peritoneal glucose absorption (% GA), and drained dialysate volume ( VD) before and after nitroprusside (NP) addition to dialysis solution in 17 long-term CAPD patients (mean duration of CAPD: 52 months) and the results were compared to those of 18 patients who were just trained for CAPD (mean duration: 0.6 month). There were no differences in the control (without NP) Curea, Ccr, D PC, %GA, and VD between the new and long-term CAPD patients. Curea, Ccr, and D PC increased significantly with NP in both new and long-term patients. Curea and Ccr with NP were not different between the new and long-term patients but D PC with NP was significantly lower in the long-term CAPD patients. The results of this study suggest that peritoneal solute clearances and the responsiveness of peritoneal microcirculation to NP remain unchanged after four years of CAPD, despite recurrent episodes of peritonitis.

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Determining Peritoneal Dialysis Prescriptions by Employing a Patient -Specific Protocol

Peritoneal Dialysis International ◽

10.1177/089686089301300305 ◽

1993 ◽

Vol 13 (3) ◽

pp. 189-193 ◽

Cited By ~ 5

Author(s):

Paul M. Zabetakis ◽

Randi Krapf ◽

Maria v. DeVita ◽

Gilbert W. Gleim ◽

Michael F. Michelis

Keyword(s):

New York ◽

Peritoneal Dialysis ◽

Creatinine Clearance ◽

Treatment Protocol ◽

Specific Treatment ◽

Simple Calculation ◽

Patient Specific ◽

Specific Protocol ◽

Continuous Cycling ◽

Dialysate Volume

Objective To develop a formula that would permit a rapid and simple calculation of required dialysate volume needed to provide a predetermined daily creatinine clearance. Design Prospective study of peritoneal dialysis patients followed for 6 months. Setting A primary care teaching hospital in New York. Patients Twenty-six patients beginning peritoneal dialysis entered and completed the study. Intervention By employing each patient's measured peritoneal equilibration test (PET) and a standard clearance formula, a patient-specific treatment protocol (PSP) was calculated. The PET 2-hour DIP croat was used for continuous cycling peritoneal dialysis (CCPD) and the 4hour DIP patients on continuous ambulatory peritcornoeal dialysis (CAPD) to determine a PSP that would provide a minimum of 6 L of creatinine clearance daily. Main Outcome Measures Patients were followed for 6 months to assess the ability of this approach of maintaining acceptable levels of blood urea nitrogen, creatinine, albumin, and hematocrit over the 6–month period of observation. Results Our study of 26 patients revealed that only 6 patients (23%) could be treated with the standard prescription of 8 L/day on CAPD. The remaining 77% of our patients required 9–13 L/day for CAPD and 12–21 L/day for CCPD. All patients were free of uremic symptoms and demonstrated acceptable biochemical parameters over a 3–6 month period of observation. Conclusions A patient-specific protocol utilizing individually derived PET data provides an acceptable and easy to calculate initial treatment prescription for each patient that avoids the necessity for trial and error that has heretofore been employed.

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Association of adipocytokines with peritoneal function

Peritoneal Dialysis International ◽

10.1177/0896860819896133 ◽

2020 ◽

pp. 089686081989613

Author(s):

Yuichiro Sumi ◽

Yukinao Sakai ◽

Kosuke Terada ◽

Yusuke Otsuka ◽

Tomoyuki Otsuka ◽

...

Keyword(s):

Predictive Factor ◽

Urine Output ◽

Density Lipoprotein ◽

Blood Cholesterol ◽

Factors Affecting ◽

Test Items ◽

Function Preservation ◽

Glucose Exposure ◽

Peritoneal Function ◽

Dialysate Volume

Background: Preservation of peritoneal function is crucial for the continuation of peritoneal dialysis (PD). A previous study suggested that blood cholesterol is involved in the preservation of peritoneal function; therefore, we determined whether adipocytokines can predict peritoneal function preservation. Methods: Eighty patients were enrolled. Serum adiponectin, leptin, apelin, various blood components, and estimated glomerular filtration rate (eGFR) (mL/min/m2) were measured. In addition, the duration of PD, presence or absence of peritonitis and diabetes mellitus, body mass index, urine output, peritoneal Kt/ V, renal Kt/ V, weekly Kt/ V, peritoneal creatinine clearance rate (CCr), renal CCr, weekly CCr, use or nonuse of statin products, dialysate volume, glucose exposure, and use or nonuse of icodextrin dialysate were assessed. Peritoneal equilibration tests were performed at 6-month intervals, and dialysate-to-plasma [D/P] ratio and glucose uptake ratio [D/D0] were measured. Associations of the baseline values and their percent changes with various adipocytokines and test items were evaluated. Results: Multiple regression analyses identified adiponectin ( p = 0.0392, p = 0.0348) as a significant predictive factor of D/P and D/D0 ratios. eGFR was identified as a significant predictive factor ( p = 0.015) of percent change in the D/P ratio. Apelin ( p = 0.0484), high-density lipoprotein cholesterol ( p = 0.0066), dialysate volume ( p = 0.0223), and urine output ( p = 0.0020) were identified as factors affecting the duration of PD. Conclusions: Adipocytokines are a predictive factor of peritoneal function and the duration of PD in patients undergoing PD.

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The design of an optimized portable artificial kidney system using recirculation and regeneration of dialysate

Proceedings of the Institution of Mechanical Engineers Part H Journal of Engineering in Medicine ◽

10.1243/0954411981534141 ◽

1998 ◽

Vol 212 (5) ◽

pp. 373-381 ◽

Cited By ~ 2

Author(s):

R J A Bigsby ◽

R J Rider ◽

G N Blount

Keyword(s):

Activated Carbon ◽

Small Volume ◽

Operating Conditions ◽

Artificial Kidney ◽

Design Solution ◽

Peltier Effect ◽

Prototype System ◽

Dialysis Session ◽

Dialysate Volume ◽

Dialysate Temperature

This paper is intended as an overview of the research carried out at Coventry University in the design of a portable artificial kidney system. It was seen that the key to the problem was the reduction in dialysate volume, and so it was decided to develop a prototype that would utilize the regeneration and recirculation of a small volume of dialysate. A prototype system has been produced and used to simulate a dialysis session. Activated carbon was used as a sorbent for the regeneration of the dialysate, circulating in a closed loop. For the purpose of this work, the adsorption of urea was investigated as this is, volumetrically, the major solute to be removed. Peltier effect cooling was used to vary the dialysate temperature down to 2 °C, as activated carbon will adsorb greater amounts of urea at lower temperatures. A series of tests was then carried out to investigate the effect of dialysate temperature, flowrate and volume on the amount of urea that could be dialysed. From the experimental results, a model of the system was derived, which made it possible to determine the implications of different operating conditions on the overall mass and size of a portable dialysis system. The output of this model was then used to establish a design specification and produce an optimum design solution for the system.

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The Necessity of Adjusting Dialysate Volume to Body Surface Area in Pediatric Peritoneal Equilibration Tests

Peritoneal Dialysis International ◽

10.1177/089686089701700219 ◽

1997 ◽

Vol 17 (2) ◽

pp. 199-200 ◽

Cited By ~ 12

Author(s):

Alberdina W. De Boer ◽

Theodora C.J.G. Van Schaijk ◽

Hans L. Willems ◽

Roel E. Reddingius ◽

Leo A.H. Monnens ◽

...

Keyword(s):

Surface Area ◽

Body Surface Area ◽

Body Surface ◽

Dialysate Volume

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Peritoneal dialysis for acute kidney injury: Equations for dosing in pandemics, disasters, and beyond

Peritoneal Dialysis International ◽

10.1177/0896860820970066 ◽

2020 ◽

pp. 089686082097006

Author(s):

Chang Yin Chionh ◽

Fredric O Finkelstein ◽

Claudio Ronco

Keyword(s):

Acute Kidney Injury ◽

Peritoneal Dialysis ◽

Kidney Injury ◽

Response To Treatment ◽

Cycle Duration ◽

Weekly Dose ◽

Target Dose ◽

Primary Determinant ◽

Total Body ◽

Dialysate Volume

Background: Peritoneal dialysis (PD) is a viable option for renal replacement therapy in acute kidney injury (AKI), especially in challenging times during disasters and pandemics when resources are limited. While PD techniques are well described, there is uncertainty about how to determine the amount of PD to be prescribed toward a target dose. The aim of this study is to derive practical equations to assist with the prescription of PD for AKI. Methods: Using established physiological principles behind PD clearance and membrane transport, a primary determinant of dose delivery, equations were mathematically derived to estimate dialysate volume required to achieve a target dose of PD. Results: The main derivative equation is VD = (1.2 × std- Kt/ V × TBW)/( t dwell + 4), where VD is the total dialysate volume per day, std- Kt/ V is the desired weekly dose, TBW is the total body water, and t dwell is the dwell time. VD can be expressed in terms of dwell volume, v dwell, by VD = (0.3 × std- Kt/ V × TBW) − (6 × v dwell). Two further equations were derived which directly describe the mathematical relationship between t dwell and v dwell. A calculator is included as an Online Supplementary Material. Conclusions: The equations are intended as a practical tool to estimate solute clearances and guide prescription of continuous PD. The estimated dialysate volume required for any dose target can be calculated from cycle duration or dwell volume. However, the exact target dose of PD is uncertain and should be adjusted according to the clinical circumstances and response to treatment. The equations presented in this article facilitate the adjustment of PD prescription toward the targeted solute clearance.

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HOME NOCTURNAL HEMODIALYSIS WITH LOW DIALYSATE VOLUME: A CROSS-OVER STUDY

American Journal of Kidney Diseases ◽

10.1053/j.ajkd.2015.03.011 ◽

2015 ◽

Vol 65 (5) ◽

pp. A2

Keyword(s):

Nocturnal Hemodialysis ◽

Dialysate Volume

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Incremental peritoneal dialysis in incident end-stage kidney disease patients

Peritoneal Dialysis International ◽

10.1177/08968608211036796 ◽

2021 ◽

pp. 089686082110367

Author(s):

Hao Yan ◽

Zita Abreu ◽

Joanne M Bargman

Keyword(s):

Peritoneal Dialysis ◽

Kidney Disease ◽

Comprehensive Evaluation ◽

Close Monitoring ◽

End Stage Kidney Disease ◽

Baseline Serum ◽

Lower Baseline ◽

Clinical Responses ◽

End Stage ◽

Dialysate Volume

Background: This retrospective cohort study investigated the characteristics and outcomes of the end-stage kidney disease (ESKD) patients treated with incremental peritoneal dialysis (PD) at a large academic centre. Methods: ESKD patients initiating PD with a dialysate volume ≤6 L/day were analysed. Results: One hundred and seventy-five patients were included and were followed up for 352.6 patient-years. The baseline residual kidney function (RKF) was 8.3 ± 3.4 mL/min/1.73 m2. The unadjusted 1- to 5-year patient survival rate was 89.6%, 80.4%, 65.4%, 62.7% and 48.8%, respectively, and the corresponding time on PD therapy rate was 95.1%, 89.1%, 89.1%, 82.4% and 77.6%. Greater initial PD dose (hazard ratio = 1.608, 95% confidence interval 1.089–2.375) was associated with death after adjusting for age, Charlson comorbidity index (CCI), haemodialysis prior to PD, assisted PD and baseline RKF, likely as a result of residual confounding. There was no association with PD discontinuation. The average peritonitis rate and hospitalisation rate were 0.122 and 0.645 episodes per patient-year, respectively. The dialysate volume increased from 4.5 (4.3–5.7) L/day to 8.0 (6.0–9.8) L/day at 5 years. Fifty-seven (32.6%) patients graduated to full-dose PD at a median time of 10.3 (6.2, 15.7) months. Male sex, greater body mass index and lower baseline serum albumin were risk factors for increasing PD dose to over 6 L/day within 1 year. Conclusions: Incremental PD is a safe approach to initiate dialysis, and it offers satisfactory outcomes. Close monitoring, comprehensive evaluation of clinical responses and prompt adjustment of the prescription as needed play a crucial role in this patient-centred treatment.

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