Influence of Peritoneal Dialysate Flow Rate on the Pharmacokinetics of Cefazolin

2003 ◽  
Vol 23 (5) ◽  
pp. 469-474 ◽  
Author(s):  
Harold J. Manley ◽  
Darcie L. Bridwell ◽  
Rowland J. Elwell ◽  
George R. Bailie
Keyword(s):  
Flow Rate ◽  
Continuous Flow ◽  
Elimination Rate ◽  
Coefficient Of Determination ◽  
P Value ◽  
Data Set ◽  
Dialysate Flow ◽  
Medline Search ◽  
Dialysate Flow Rate ◽  
The Impact

Objective To determine the impact of dialysate flow rate (DFR) on cefazolin pharmacokinetics (PK) in peritoneal dialysis (PD) patients. Methods A meta-analysis of published reports, identified by MEDLINE search (1966-2002) and other sources, containing information on cefazolin PK data in PD patients was conducted. Data were analyzed based upon low DFR (≤ 5.50 mL/minute) or high DFR (> 5.50 mL/minute). Data available were from North American (NA) ( n = 45) and Singaporean ( n = 10) patients. Complete data sets were available for 33 patients (CDS patients). Data were analyzed with respect to data origin and data set completeness: all patients (ALL), NA, and CDS. Analysis of log-transformed cefazolin PK data was performed to determine coefficient of determination ( r2) between DFR and cefazolin elimination rate constant (kel), clearance total (ClT), and clearance peritoneal (ClPD). Clearance total data were extrapolated to DFR observed in continuous flow PD. Results Published literature provided data on 55 PD patients (12 high DFR, 43 low DFR). Regardless of data origin (ALL, NA, or CDS), a prominent coefficient of determination ( p < 0.0001) existed between DFR and all cefazolin PK data except ClPD. The p value for DFR correlation to ClPD was 0.953, 0.011, and 0.036 for ALL, NA, and CDS patients, respectively. Cefazolin ClT and ClPD increased at higher DFRs. Conclusion These findings demonstrate that an increased DFR leads to an increased rate of cefazolin clearance in NA PD patients. The impact of Asian descent on cefazolin ClPD warrants further investigation. Clinicians dosing cefazolin in PD patients using a higher DFR than that used to determine cefazolin PK should use increased doses or prescribe lower/comparable DFRs. Data are not yet available for patients prescribed very high DFRs ( e.g., continuous flow PD); extrapolation of our results demonstrates significant influences on clearance and risk for underdosing.

Does the Blood Pump Flow Rate have an Impact on the Dialysis Dose During Low Dialysate Flow Rate Hemodialysis?

2018 ◽  
Vol 46 (4) ◽  
pp. 279-285 ◽  
Author(s):  
Maxime Leclerc ◽  
Clémence Bechade ◽  
Patrick Henri ◽  
Elie Zagdoun ◽  
Erick Cardineau ◽  
...  
Keyword(s):  
Flow Rate ◽  
Blood Pump ◽  
Bivariate Analysis ◽  
Dialysis Dose ◽  
Dialysate Flow ◽  
Pump Flow ◽  
Dialysate Flow Rate ◽  
Pump Flow Rate ◽  
A Prospective Study ◽  
The Impact

We conducted a prospective study to assess the impact of the blood pump flow rate (BFR) on the dialysis dose with a low dialysate flow rate. Seventeen patients were observed for 3 short hemodialysis sessions in which only the BFR was altered (300,350 and 450 mL/min). Kt/V urea increased from 0.54 ± 0.10 to 0.58 ± 0.08 and 0.61 ± 0.09 for BFR of 300, 400 and 450 mL/min. For the same BFR variations, the reduction ratio (RR) of β2microglobulin increased from 0.40 ± 0.07 to 0.45 ± 0.06 and 0.48 ± 0.06 and the RR phosphorus increased from 0.46 ± 0.1 to 0.48 ± 0.08 and 0.49 ± 0.07. In bivariate analysis accounting for repeated observations, an increasing BFR resulted in an increase in spKt/V (0.048 per 100 mL/min increment in BPR [p < 0.05, 95% CI (0.03–0.06)]) and an increase in the RR β2m (5% per 100 mL/min increment in BPR [p < 0.05, 95% CI (0.03–0.07)]). An increasing BFR with low dialysate improves the removal of urea and β2m but with a potentially limited clinical impact.

P1055REMARKABLE REMOVALS OF BETA-2-MICROGLOBULIN AND PHOSPHATE WITH SHORT-DAILY HOME HEMODIALYSIS USING LOW DIALYSATE FLOW RATE

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Mercedes Gonzã¡lez Moya ◽  
Pablo Molina ◽  
Belén Vizcaíno ◽  
María Rodrigo ◽  
Pilar Pascual ◽  
...  
Keyword(s):  
Flow Rate ◽  
Uremic Toxins ◽  
Volume Control ◽  
Dialysis Session ◽  
Single Session ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
The Mean ◽  
The Impact ◽  
Dialysate Volume

Abstract Background and Aims Short-daily hemodialysis (HD) with low-dialysate volume is an appealing portable dialysis approach for home use. Although this type of HD has proved being effective for the volume control and the clearance of low molecular-weight uremic toxins, limited data are available on the impact on the removal rates of other uremic toxins like β2-microglobulin (β2M) or phosphate (P), whose clearance is limited by sequestration into compartments, poor diffusion, high time-dependency, or protein binding. We evaluated the impact of short-daily HD with slow dialysate flow rate on the removal of solutes of different molecular weights and distribution volumes. Method Single-session and weekly balances of β2M, P, urea, and creatinine were prospectively assessed with total dialysate collection and serum measurements before and after 341 dialysis sessions (mean dialysate volume: 30963 ± 862 mL; mean length of dialysis session: 153 ± 8 min) in 31 stable patients (female; 9, 29 %; mean age: 55.6 ± 13.6 y; dry weight: 74.9 ± 13.3 kg) undergoing short-daily home HD with NxStage cycler, between July 2014 and October 2019. The mean blood flow rate was 365 ± 17 mL/min, whereas the mean dialysate flow rate was 194 ± 12 mL/min. Results Single-session β2M, P, urea, and creatinine removals were 0.138 ± 0.050 g, 0.610 ± 0.161 g, 18.89 ± 6.07 g and 1.07 ± 0.31 g, respectively, whereas the reduction rates (%) were 38.0 ± 13.0, 46.8 ± 8.6, 48.2 ± 7.0 and 46.6 ± 6.6, for β2M, P, urea and creatinine, respectively. The estimated weekly β2M, P, urea and creatinine removals in HDD patients dialyzing 5-6 days per week were comparable with 4-h in-center thrice-weekly on-line hemodiafiltration according to previous studies (Table 1). Conclusion Treating patients with short-daily HD with low-dialysate volume at a 5-6 days per week prescription may achieve an efficient weekly β2M and P removal.

scholarly journals Manual Individualization of the Dialysate flow according to blood flow: Effects on the Hemodialysis dose delivered and on Dialysate consumption

2020 ◽  
Author(s):  
FAYE Moustapha ◽  
Niakhaleen KEITA ◽  
Maria Faye ◽  
Yousseph BERDAI ◽  
Ahmed Tall LEMRABOTT ◽  
...  
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Dialysis Dose ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Flow Effects ◽  
The Impact

Abstract Background: The objective of this work was to assess the impact of the decrease in dialysate flow rate on the dialysis dose delivered (spKt /V) to chronic hemodialysis patients and to estimate the resulting water saving. Methods: It was a prospective 4-week-period study that included chronic hemodialysis patients with clinical and hemodynamic stability. The patients successively underwent hemodialysis with a dialysate flow rate of 500 ml / min, at 1, 1.2 and 1.5 times the blood flow rate. Each dialysate flow rate was applied for one week. During these 4 weeks, the following parameters were kept constant: duration of dialysis, blood flow rate, anticoagulation, membrane nature and surface. Results: Forty-five chronic hemodialysis patients were included with a mean age of 48.4 ± 12.07 years. The weekly average spKt/V was statistically higher with a dialysate flow rate at 1.5 times the blood flow rate compared to the dialysate flow at 500 mL / min (p = 0.001). The proportion of patients achieving a standardized dialysis dose ≥ 1.4 was statistically higher with dialysate flow at 500 mL / min (64.4%) compared to dialysate flow at 1 or 1.2 times the blood flow rate which were 57.8% and 55.6%, respectively. It was statistically higher with a dialysate flow at 1.5 times the blood flow (93.3%) compared to the dialysate flow at 500 mL / min (p = 0.036). The dialysate volume used with a dialysate flow rate of 500 mL / min was higher compared to the other dialysate flow rates (p = 0.0001). Conclusions: An adequate dialysis dose could be achieved with a dialysate flow rate of 1.5 times the blood flow rate, thereby saving significant amount of water.

Computer Simulations of Continuous Flow Peritoneal Dialysis Using the 3-Pore Model—A First Experience

2019 ◽  
Vol 39 (3) ◽  
pp. 236-242 ◽  
Author(s):  
Carl M. Öberg ◽  
Giedre Martuseviciene
Keyword(s):  
Peritoneal Dialysis ◽  
Flow Rate ◽  
In Silico ◽  
Continuous Flow ◽  
High Volume ◽  
Dialysis Fluid ◽  
Pore Model ◽  
Dialysate Flow ◽  
Dialysate Flow Rate

Background Continuous flow peritoneal dialysis (CFPD) is performed using a continuous flux of dialysis fluid via double or dual-lumen PD catheters, allowing a higher dialysate flow rate (DFR) than conventional treatments. While small clinical studies have revealed greatly improved clearances using CFPD, the inability to predict ultrafiltration (UF) may confer a risk of potentially harmful overfill. Here we performed physiological studies of CFPD in silico using the extended 3-pore model. Method A 9-h CFPD session was simulated for: slow (dialysate to plasma creatinine [D/P crea] < 0.6), fast (D/P crea > 0.8) and average (0.6 < D/P crea < 0.8) transporters using 1.36%, 2.27%, or 3.86% glucose solutions. To avoid overfill, we applied a practical equation, based on the principle of mass-balance, to predict the UF rate during CFPD treatment. Results Increasing DFR > 100 mL/min evoked substantial increments in small- and middle-molecule clearances, being 2 - 5 times higher compared with a 4-h continuous ambulatory PD (CAPD) exchange, with improvements typically being smaller for average and slow transporters. Improved UF rates, exceeding 10 mL/min, were achieved for all transport types. The β2-microglobulin clearance was strongly dependent on the UF rate and increased between 60% and 130% as a function of DFR. Lastly, we tested novel intermittent-continuous regimes as an alternative strategy to prevent overfill, being effective for 1.36% and 2.27%, but not for 3.86% glucose. Conclusion While we find substantial increments in solute and water clearance with CFPD, previous studies have shown similar improvements using high-volume tidal automated PD (APD). Lastly, the current in silico results need confirmation by studies in vivo.

scholarly journals INADEQUACY OF DIALYSIS

2018 ◽  
Vol 25 (03) ◽  
pp. 434-439
Author(s):  
Aurangzeb Afzal ◽  
Adnan Shabbir ◽  
Maira Iqbal Malik
Keyword(s):  
Blood Flow ◽  
Flow Rate ◽  
Blood Flow Rate ◽  
Reduction Ratio ◽  
Maintenance Hemodialysis ◽  
P Value ◽  
Second Phase ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Urea Reduction Ratio

Background: Objectives: In patients with end stage renal disease, inadequatedialysis can lead to increased morbidity and mortality. We conducted a study to analyze effectsof increasing dialysate flow rate (DFR) and blood flow rate (BFR) on adequacy of dialysis.URR was used as an indicator of dialysis adequacy. Study Design: Prospective comparativestudy. Period: 02 months (February 2017 to March 2017). Setting: Department of Nephrology,Lahore General Hospital. Method: 40 patients on maintenance hemodialysis were included.We divided study in three phases. First phase with blood flow 300mL/min dialysate flow 500mL/min. Second phase blood flow 350mL/min dialysate flow 500mL/min. Third phase blood flow300mL/min dialysate flow rate 800mL/min. Blood samples were collected before and after eachdialysis session. Urea reduction ratio (URR) was used to measure delivered dose of dialysis andwas assessed at the two levels of dialysate flow rate and two blood flow rates. Statistical analysiswas done by using SPSS 23.0 software package. P values <0.05 was taken as statisticallysignificant. Result: After statistical analysis we reached the conclusion that enhancing bloodflow rate from 300 to 350 is associated with an increase of URR of 6.9 % as compared toincreasing dialysate flow rate from 500 to 800 of 4.6%. In both settings increase in URR wasclinically significant. We can also deduce that increase in dialysate flow will allow us to achievea substantial increase in dialysis dose as assessed by urea reduction ratio for a given amountof dialysis time when we are unable to achieve a high blood flow rate. Difference in increasein URR for two groups one with increased blood flow and other with increased dialysate flowwas statistically insignificant (p value >0.05). Conclusion: Our study shows that if we increaseblood flow rate to 350 mL/min from 300 mL/min and dialysate flow rate to 800 mL/min from usual500 mL/min there is significant increase in URR and adequacy of dialysis. We can decreasemortality and morbidity by increasing adequacy to optimal level using both methods accordingto patient feasibility and clinical status.

Myoglobin Clearance during Continuous Veno-Venous Hemofiltration with or without Dialysis

1998 ◽  
Vol 21 (4) ◽  
pp. 205-209 ◽  
Author(s):  
D. Nicolau ◽  
Y.S. Feng ◽  
A.H.B. Wu ◽  
S.P. Bernstein ◽  
C.H. Nightingale
Keyword(s):  
Renal Failure ◽  
Animal Model ◽  
Flow Rate ◽  
Major Complication ◽  
Viable Option ◽  
Effective Technique ◽  
Dialysate Flow ◽  
Continuous Arteriovenous Hemofiltration ◽  
Pump Rate ◽  
Dialysate Flow Rate

The management of acute myoglobinuric renal failure, the major complication of rhab-domyolysis, continues to be a treatment dilemma for the clinician as limited therapeutic options are available. Previously, we have demonstrated that continuous arteriovenous hemofiltration (CAVH) is an effective technique for removing myoglobin in an animal model. In the present study, swine were administered four grams of equine myoglobin intravenously and underwent the continuous veno-venous hemofiltration (CVVH) procedure for six hours each. Animals were studied in each of the following groups: CVVH at a pump rate 100 ml/minute, CVVH at a pump rate 200 ml/minute and CVVH at a pump rate 100 ml/minute plus dialysis at a dialysate flow rate of one Liter/h. Once the filtering process was initiated there was a rapid and sustained production of ultrafiltrate in all groups. The amount of myoglobin excreted in the ultrafiltrate over the six-hour filtering period was 688, 948 and 570 mg which corresponded to 17, 24 and 14 percent of the administered dose, respectively, for the three treatments. In comparison to previous CAVH experiments, CVVH removed more circulating myoglobin and the addition of the dialysis component did not appear to improve removal. Based on these findings, it appears that the CVVH hemofiltration system is a viable option for the removal of systemic myoglobin.

Quantitating Dialysis using two Dialysate Samples: A Simple, Practical and Accurate Approach for Evaluating Urea Kinetics

1997 ◽  
Vol 20 (8) ◽  
pp. 422-427 ◽  
Author(s):  
D.S.C. Raj ◽  
S. Tobe ◽  
C. Saiphoo ◽  
M.A. Manuel
Keyword(s):  
Kinetic Parameters ◽  
Flow Rate ◽  
Volume Of Distribution ◽  
Mean Difference ◽  
Recent Analysis ◽  
Altman Plot ◽  
Bland Altman Plot ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Urea Kinetics

Urea kinetics is now widely used to determine the adequacy of dialysis. Several simplified formulae are currently in use but only a few have been accepted into clinical practice because of their simplicity and ease of calculation. A recent analysis of these formulae showed that for the same set of blood urea values the calculated Kt/V can range from 1.0 to 1.5. We have developed a new dialysate-based method (2DSM) to estimate the urea kinetic parameters using dialysate and blood samples taken at the beginning and at the end of dialysis. The total urea removed (TUR) was calculated from the geometric mean of the two dialysate samples, dialysate flow rate and the duration of dialysis. The Watson formula was used to determine the volume of distribution of urea. A comparison of the 2DSM and the direct dialysate quantification (DDQ) method showed the following results (mean ± sd, n = 52): for total urea removal (TUR) 697 ± 32 vs 722 ± 37 mmol (p = 0.6, r2 = 0.928, y = 101 + 0.83 ×, mean difference 25 ± 76 mmol, see Bland-Altman plot), dialysate urea concentration (Durea) 5.55 ± 0.25 vs 5.75 ± 0.29 mmol/l (p = 0.6, r2 = 0.928, y = 0.8 + 0.82 x, mean difference 0.2 ± 0.6 mmol, see Bland-Altman plot), dialyser clearance (K) 232 ± 4.4 vs 235 ± 5.6 ml/min (p - 0.54), Kt/V 1.42 ± 0.04 vs 1.51 ± 0.04 (p = 0.21), volume of distribution of urea (Vd) 40.14 ± 1.04 vs 38.74 ± 1.2 L, (p = 0.38), and PCR 64.6 ± 2.6 vs 68.1 ± 3.1 g/day. We have developed a simple method of determining dialysate-based urea kinetics which requires two dialysate samples, one at the beginning and one at the end of dialysis and a blood sample at the midpoint of dialysis. TUR can be calculated using the dialysate flow rate and the dialysis duration and once this is known all the other kinetic parameters can be calculated.

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