Single Session and Weekly Beta 2-Microglobulin Removal with Different Dialytic Procedures: Comparison between High-Flux Standard Bicarbonate Hemodialysis, Post-Dilution Hemodiafiltration, Short Frequent Hemodialysis with NxStage Technology and Automated Peritoneal Dialysis

2019 ◽  
Vol 48 (1) ◽  
pp. 86-96 ◽  
Author(s):  
Chiara Carla Maria Brunati ◽  
Francesca Gervasi ◽  
Mara Cabibbe ◽  
Federica Ravera ◽  
Alberto Menegotto ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Removal Rate ◽  
High Flux ◽  
Automated Peritoneal Dialysis ◽  
Single Session ◽  
Daily Dialysis ◽  
On Line ◽  
Beta 2 Microglobulin ◽  
Few Data ◽  
The Impact

Background: NxStage System One cycler (NSO) is a widespread system for home daily dialysis. Few data are available on the impact of this “low dialysate volumes system” on the removal rate of poorly diffusible, time-dependent solutes like β2-microglobulin (β2M). Methods: Single-session and weekly balances of β2M were performed and compared in 12 patients on daily NSO, 13 patients on standard high-flux bicarbonate dialysis (BHD), 5 patients on standard post-dilution on line hemodiafiltration (HDF), and 13 patients on automated peritoneal dialysis (APD). Results: Intradialytic fall of plasma water β2M levels (corrected for rebound) was 65.2 ± 2.6% in HDF, 49.8 ± 9.1% in BHD, and 32.3 ± 6.4% in NSO (p < 0.001 between all groups). Single treatment dialysate removal was much less in APD (19.4 ± 20.4 mg, p < 0.001) than in any extracorporeal technologies, and was less in NSO (126.2 ± 35.6 mg, p < 0.001) than in BHD (204.9 ± 53.4 mg) and HDF (181.9 ± 37.6 mg), with no differences between the latter 2; however weekly removal was higher in NSO (757.3 ± 213.7 mg, p < 0.04) than in BHD (614.8 ± 160.3 mg) and HDF (545.8 ± 112.8 mg). Extrapolated β2M adsorption to the membrane was negligible in BHD, 14.7 ± 9.5% of total removal in HDF and 18.3 ± 18.5% in NSO. Integration of single session data into a weekly efficiency indicator (K × t) showed total volume of plasma cleared in NSO (33.4 ± 7.7 L/week) to be higher than in BHD (26.9 ± 7.2 L/week, p < 0.01) and not different than in HDF (36.2 ± 4.7 L/week); it was negligible (3.2 ± 1.0) in APD. Conclusions: Weekly β2M removal efficiency proved equal and highest in HDF and NSO (at a 6/week prescription), slightly lesser in BHD and lowest in APD.

HomeChoice Automated Peritoneal Dialysis Machines: The Impact of Reuse of Tubing and Cassettes

2000 ◽  
Vol 20 (3) ◽  
pp. 336-338 ◽  
Author(s):  
Josephine Chow ◽  
Colleen Munro ◽  
Mary Wong ◽  
Noemir Gonzalez ◽  
Maggie Ku ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Automated Peritoneal Dialysis ◽  
The Impact

Haemofiltration and haemodiafiltration

2018 ◽  
Author(s):  
Francesco Locatelli ◽  
Celestina Manzoni ◽  
Giuseppe Pontoriero ◽  
Vincenzo La Milia ◽  
Salvatore Di Filippo
Keyword(s):  
Chronic Kidney Disease Stage ◽  
Cost Effective ◽  
Convective Transport ◽  
Disease Stage ◽  
High Flux ◽  
Beneficial Effects ◽  
Positive Effects ◽  
Randomized Controlled ◽  
On Line ◽  
The Impact

Many observational studies have consistently shown that high-flux haemodialysis (hf-HD) has positive effects on the survival and morbidity of uraemic patients when compared with low-flux haemodialysis, and mainly considering the results of Membrane Permeability Outcome (MPO) studies there is evidence favouring high-flux treatments. A further improvement in convective treatments is represented by the on-line modality. On-line preparation from fresh dialysate by a cold-sterilizing filtration process is a cost-effective method of providing large volumes of infusion solution. Randomized, controlled, large-sized trials with long follow-up in haemofiltration (HF) are unfortunately lacking, possibly suggesting the difficulties in performing these trials, mainly in providing the same urea Kt/V considered adequate in HD. On-line haemodiafiltration (HDF) is considered the most efficient technique of using high-flux membranes, and clearances of small solutes like urea are higher in HDF than in HF and of middle solutes like β‎‎‎2-microglobulin are higher than in hf-HD. Thus HDF, as a strategy based on simultaneous diffusive and convective transport, may combine the beneficial effects of diffusive standard HD with the possible advantages of convective HF. Five large, randomized controlled trials just concluded are inconclusive in definitively clarifying the impact of on-line HDF on chronic kidney disease stage 5 patient outcomes.

scholarly journals Automated peritoneal dialysis with 'on-line'-prepared bicarbonate-buffered dialysate: technique and first clinical experiences

1998 ◽  
Vol 13 (12) ◽  
pp. 3189-3192 ◽  
Author(s):  
R. Brunkhorst ◽  
S. Fromm ◽  
E. Wrenger ◽  
A. Berke ◽  
R. Petersen ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Clinical Experiences ◽  
Automated Peritoneal Dialysis ◽  
On Line

scholarly journals P1223PATIENT REMOTE MONITORING IN AUTOMATED PERITONEAL DIALYSIS: 2017-2019 CLINICAL EXPERIENCE IN A SINGLE CENTER

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Gianpaolo Amici ◽  
Antonina Lo Cicero ◽  
Mery Zuccolo ◽  
Rosella Ferraro Mortellaro ◽  
Dino Romanini ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Remote Patient Monitoring ◽  
Automated Peritoneal Dialysis ◽  
Telemedicine System ◽  
Daily Monitoring ◽  
Hill Area ◽  
Remote Patient ◽  
The Impact

Abstract Background and Aims We conducted an observational study in a group of patients in automated peritoneal dialysis (APD) to evaluate the impact of the introduction and the long-term use of a telemedicine system for remote patient monitoring (RPM, Claria Sharesource Baxter). Method From April 1 2017 to December 31 2019 (33 months) we followed 42 APD patients with RPM, sex F 20 M 22, age 70±14 years, on PD treatment for median 10 (IQR 3-23) months, distance from the center 18±14 km in mountain and hill area. Have been studied 505 months of RPM overall, per patient median 9 (IQR 3-19) months, corresponding to 11685 APD sessions overall, per patient median 206 (IQR 52-457) sessions. Results Have been registered 1125 alarms (red flags) overall, per patient median 9 (IQR 1-45) alarms, rate 2.2 alarms patient-month (0.1 alarms per session). Analyzing the causes of the alarms: “dwell time lost” (&gt;45 min) 1006 (89%), “drain anticipation” (&gt;2 times) 22 (2%), “fill or dwell bypass” (&gt;3 times) 15 (1%), “various causes” (&gt;10 times) 86 (8%). “Various causes” alarm group sums mainly slow drain for set kinking and insufficient drain volume. We count 195 remote modifications of dialysis program overall, median per patient 3 (IQR 1-7), rate 0.02 patient month with a ratio 0.2 modifications per alarm. Looking to program modification, the alarm type specifically linked to modifications has been insufficient drain volume of the “various causes” group (36 events, 18% of all modifications). We found a positive correlation between the number of treatments and alarms (r=0.534, p&lt;0.001). In the observation period the overall hospitalization days were 403, rate 0.8 days patient month, ratio 0.02 hospitalization days per APD RPM session and ratio 0.4 hospitalization days per alarm. Conclusion The study shows that APD with RPM improves patients’ follow-up changing the organization of the center. In the long term the telemedicine system shows the advantages of a careful and daily monitoring. The rates of alarm, change of prescription and hospitalization resulted very low in our experience.

scholarly journals Water Removal Cycle-By-Cycle During Automated Peritoneal Dialysis: Assessment by Remote Patient Monitoring and Modelling of Peritoneal Tissue Hydration

2021 ◽  
Author(s):  
Joanna Stachowska-Pietka ◽  
Beata Naumnik ◽  
Ewa Suchowierska ◽  
Rafael Gomez ◽  
Jacek Waniewski ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Monitoring ◽  
Water Removal ◽  
Remote Patient Monitoring ◽  
Automated Peritoneal Dialysis ◽  
Fluid Exchange ◽  
Tissue Hydration ◽  
Peritoneal Tissue ◽  
Remote Patient ◽  
The Impact

Abstract Water removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM). We analysed ultrafiltration patterns during night APD following a dry day (APDDD; no daytime fluid exchange) or wet day (APDWD; daytime exchange). Ultrafiltration for each APD exchange were recorded for 16 days using RPM in 14 patients. The distributed model of fluid and solute transport was applied to simulate APD and to explore the impact of changes in peritoneal tissue hydration on ultrafiltration. We found lower ultrafiltration (mL, median [first quartile-third quartile]) during first and second vs. consecutive exchanges in APDDD (-61 [-148—27], 170 [78—228] vs. 213 [126—275] mL; p<0.001), but not in APDWD (81 [-8—176], 81 [-4—192] and 115 [4—219] mL; NS). Simulations in a virtual patient showed that lower ultrafiltration (by 114 mL) was related to increased peritoneal tissue hydration caused by inflow of 187 mL of water during the first APDDD exchange. The observed phenomenon of lower ultrafiltration during initial exchanges of dialysis fluid in patients undergoing APDDD appears to be due to water inflow into the peritoneal tissue, re-establishing a state of increased hydration typical for peritoneal dialysis.

P1051ASINGLE SESSION AND WEEKLY BETA 2 MICROGLOBULIN REMOVAL DURING SHORT FREQUENT HEMODIALYSIS USING PHYSIDIA TECHNOLOGY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Michel Thomas ◽  
Eric Vincent ◽  
Veliana Todorova
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Removal Rate ◽  
Blood Flow Rate ◽  
Single Session ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Beta 2 ◽  
Beta 2 Microglobulin ◽  
Conventional Hemodialysis

Abstract Background and Aims S3 Physidia monitor is a dedicated system for short frequent hemodialysis at home based on push pull dialysis mode. Clinical data is provided to show the Beta 2 microglobulin elimination, used as a model for middle molecule removal. The aim of the study is to compare Beta 2 microglobulin removal between hemodialysis systems with low dialysate flow rate and conventional hemodialysis or hemodiafiltration. Method Analyzed data is collected during multicentric clinical study performed to evaluate the safety and performances level with S3 Physidia system. This clinical investigation has been conducted in accordance with the Good Clinical Practices (Helsinki Declaration), every patient was informed by the investigator and has signed the consent form prior to the completion of the study. The project has been approved by the local Committee and authorities. Anonymized data of 10 patients (age: 55.3 +/- 12.3 years, weight: 72.8 +/- 17.2 kg) is collected during 126 dialysis sessions (blood flow rate: 293 +/- 24 ml/min, dialysate flow rate: 190 +/- 14 ml/min). The convection volume (Ultrafiltration and back filtration generated by the push pull technique) is between 1 to 8 l per session (dialyzer used: Smartflux HFP190). For each session, Beta 2 microglobulin (β2M) removal rate is calculated by using pre and post dialysis β2M blood concentrations. Post concentration is corrected by using Bergström formula to take into account the hemoconcentration and rebound. Both single session (2hours) and weekly (12 hours/week) β2m removal rates were calculated. Single session and weekly β2m removal levels are compared to published data with conventional hemodialysis or post dilution hemodiafiltration. Weekly dialysis performance is evaluated according to the standardized Kt / V (sdt) according to the Gotch calculation method. Results Using S3 daily hemodialysis, weekly dialysis diffusive performance for urea (standardized Kt / V is 2.56 +/- 0.39, higher than KDIGO recommendations for frequent dialysis (min 2.1). β2M removal rate per session is 52.9 +/- 6.6 % with pre dialytic concentration average value of 25 mg/l corresponding to 73 mg of β2M removed per session. Calculated weekly β2M removal is 438 mg. These results are compared to β2M removal obtained by standard treatment procedures (ref1) and by short frequent hemodialysis using diffusive low dialysate flow (Nx Stage system One, ref 2). During conventional hemodialysis (4h, 3 sessions per week), the β2M removal rate is between 60 to 80 % corresponding to a removal of 300 to 380 mg/week (ref 1) During high volume post dilution hemofiltration (4h, 3 sessions per week, convection &gt; 20 l per session), the average β2M removal rate is 80% corresponding to a removal of 380 mg/week (ref 1) With Nx Stage device, without convective component, single session β2M removal rate is between 40 and 50 % depending on blood flow rate (maximum obtained with blood flow rate 400 ml/min) (ref 2) Ref 1: J. Potier et al, Int J Artif Organs. 2016 Nov 11;39(9):460-470 Ref 2 : M. Leclerc et al, Blood Purif 2018;46:279–285 Conclusion β2M reduction rate obtained with the S3 Physidia system is greater than 50%, removing any dowry concerning the performance of a low dialysate flow rate system. The convective component, provided by the push pull technique, must be confirmed, but these initial results are encouraging (reduction rate &gt; 50% despite a relatively low blood flow rate). Due to the frequency, the quantity of β2M weekly removed is higher than that obtained with conventional treatment methods.

scholarly journals Water removal during automated peritoneal dialysis assessed by remote patient monitoring and modelling of peritoneal tissue hydration

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Joanna Stachowska-Pietka ◽  
Beata Naumnik ◽  
Ewa Suchowierska ◽  
Rafael Gomez ◽  
Jacek Waniewski ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Monitoring ◽  
Water Removal ◽  
Remote Patient Monitoring ◽  
Automated Peritoneal Dialysis ◽  
Fluid Exchange ◽  
Tissue Hydration ◽  
Peritoneal Tissue ◽  
Remote Patient ◽  
The Impact

AbstractWater removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM). We analysed ultrafiltration patterns during night APD following a dry day (APDDD; no daytime fluid exchange) or wet day (APDWD; daytime exchange). Ultrafiltration for each APD exchange were recorded for 16 days using RPM in 14 patients. The distributed model of fluid and solute transport was applied to simulate APD and to explore the impact of changes in peritoneal tissue hydration on ultrafiltration. We found lower ultrafiltration (mL, median [first quartile, third quartile]) during first and second vs. consecutive exchanges in APDDD (−61 [−148, 27], 170 [78, 228] vs. 213 [126, 275] mL; p < 0.001), but not in APDWD (81 [−8, 176], 81 [−4, 192] vs. 115 [4, 219] mL; NS). Simulations in a virtual patient showed that lower ultrafiltration (by 114 mL) was related to increased peritoneal tissue hydration caused by inflow of 187 mL of water during the first APDDD exchange. The observed phenomenon of lower ultrafiltration during initial exchanges of dialysis fluid in patients undergoing APDDD appears to be due to water inflow into the peritoneal tissue, re-establishing a state of increased hydration typical for peritoneal dialysis.

Remote Patient Management in Automated Peritoneal Dialysis: A Promising New Tool

2018 ◽  
Vol 38 (1) ◽  
pp. 76-78 ◽  
Author(s):  
Valérie Jotterand Drepper ◽  
Pierre-Yves Martin ◽  
Catherine Stoermann Chopard ◽  
James A. Sloand
Keyword(s):  
Peritoneal Dialysis ◽  
Patient Management ◽  
Healthcare Providers ◽  
Disease Patient ◽  
Automated Peritoneal Dialysis ◽  
Technique Survival ◽  
Rpm System ◽  
Remote Patient ◽  
End Stage ◽  
The Impact

Remote patient management (RPM) has the potential to help clinicians detect early issues, allowing intervention prior to development of more significant problems. A 23-year-old end-stage kidney disease patient required urgent start of renal replacement therapy. A newly available automated peritoneal dialysis (APD) RPM system with cloud-based connectivity was implemented in her care. Pre-defined RPM threshold parameters were set to identify clinically relevant issues. Red flag dashboard alerts heralded prolonged drain times leading to clinical evaluation with subsequent diagnosis of and surgical repositioning for catheter displacement, although it took several days for newly-RPM-exposed staff to recognize this issue. Post-PD catheter repositioning, drain times were again normal as indicated by disappearance of flag alerts and unremarkable cycle volume profiles. Identification of < 90% adherence to prescribed PD therapy was then documented with the RPM system, alerting the clinical staff to address this important issue given its association with significant negative clinical outcomes. Healthcare providers face a “learning curve” to effect optimal utilization of the RPM tool. Larger scale observational studies will determine the impact of RPM on APD technique survival and resource utilization.

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