A Comparison of Clearances on Tidal Peritoneal Dialysis and Intermittent Peritoneal Dialysisa

1994 ◽  
Vol 14 (2) ◽  
pp. 145-148 ◽  
Author(s):  
Beth Piraino ◽  
Filitsa Bender ◽  
Judith Bernardini
Keyword(s):  
Peritoneal Dialysis ◽  
Small Molecule ◽  
Flow Rate ◽  
Peritoneal Equilibration Test ◽  
Urea Nitrogen ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Fill Volume ◽  
The Mean ◽  
Tidal Peritoneal Dialysis

Objectives To compare the small molecule clearances on tidal peritoneal dialysis (TPD) and intermittent peritoneal dialysis (IPD), controlling for dialysate flow rate. Design Alternating 8-hour treatments on IPD and TPD (2 of each in 6 patients), each treatment separated by 3 or more days [patients returning to continuous ambulatory peritoneal dialysis (CAPD) in the interim] were performed. IPD treatments consisted of 15 exchanges with 2 Llexchange for a total of 30 Lltreatment. TPD treatments consisted of 29 exchanges, with an initial fill volume of 2 L, followed by 1 L tidal volume for the subsequent exchanges (reserve volume of 1 L) for a total of 30 Lltreatment. Patients Six patients, with a mean dialysatelplasma (DIP) creatinine as determined by the peritoneal equilibration test (PET) of 0.64±0.1 0, were studied. Four had a low -average DIP creatinine, while 2 had a high-average DIP creatinine. Measurements Urea nitrogen, creatinine, phosphate, and potassium clearances on TPD and IPD were compared using the paired t-test. Results The dialysate flow rates were 3.7±0.1 Llhour for IPD and 3.8±0.2 Llhour for TPD. The mean dialysate dextrose was 1.9±0.5 gldL for both. The creatinine clearances were 9±2 versus 10±3 mLlminute, the urea nitrogen clearances 19±3 versus 20±3 mLlminute, and phosphate clearances 10±3 versus 11±3 mLlminute for IPD and TPD, respectively (all not different). The ultrafiltration rates were 2.9±0.9 mLlminute on IPD and 3.3±1.6 mLI minute on TPD (not different). On both IPD and TPD the clearances of urea nitrogen, creatinine, and phosphate for the 2 patients with high-average DIP creatinine were higher than for the 4 patients with low -average DIP creatinine. Conclusions When the dialysate flow rate is controlled and a TPD prescription of 1 L reserve and tidal volumes is used, the small molecule clearances on IPD are similar to those on TPD.

How to Reach Optimal Creatinine Clearances in Automated Peritoneal Dialysis

1996 ◽  
Vol 16 (1_suppl) ◽  
pp. 167-171 ◽  
Author(s):  
Pierre Yves Durand ◽  
Philippe Freida ◽  
Belkacem Issad ◽  
Jacques Chanliau
Keyword(s):  
Peritoneal Dialysis ◽  
Creatinine Clearance ◽  
Flow Rate ◽  
Clinical Results ◽  
Automated Peritoneal Dialysis ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Peritoneal Permeability ◽  
Number Of Cycles ◽  
Tidal Peritoneal Dialysis

This paper summarizes the basis of prescription for automated peritoneal dialysis (APD) established during a French national conference on APD. Clinical results and literature data show that peritoneal clearances are closely determined by peritoneal permeability and hourly dialysate flow rate, independently of dwell time or number of cycles. With APD, peritoneal creatinine clearance increases according to the hourly dialysate flow rate to a maximum (plateau), then decreases because of the multiplication of the drain-fill times. The hourly dialysate flow giving the maximum peritoneal creatinine clearance is defined as the “maximal effective dialysate flow” (MEDF). MEDF is higher for high peritoneal permeabilities: MEDF is 1.8 and 4.2 L/hr with nocturnal tidal peritoneal dialysis (TPD) for a 4-hr creatinine dialysate-to-plasma ratio (DIP) of 0.50 and 0.80, respectively. With nightly intermittent peritoneal dialysis (NIPD), MEDF is 1.6 and 2.3 Llhr for a DIP of 0.50 and 0.78, respectively. Under these conditions, tidal modalities can only be considered as a way to increase the MEDF. Using the MEDF concept for an identical APD session duration, the maximal weekly normalized peritoneal creatinine clearance can vary by 340% when 4hr DIP varies from 0.41 to 0.78. APD is not recommended when 4-hr creatinine DIP is lower than 0.50. However, the limits of this technique may be reached at higher peritoneal permeabilities in anurics because of the duration of sessions andlor the additional exchanges required by these patients.

Tidal Peritoneal Dialysis: Preliminary Experience

1992 ◽  
Vol 12 (3) ◽  
pp. 304-308 ◽  
Author(s):  
Michael J. Flanigan ◽  
Cynthia Doyle ◽  
Victoria S. Lim ◽  
Gary Ullrich
Keyword(s):  
Peritoneal Dialysis ◽  
Tertiary Care ◽  
Tidal Flow ◽  
Clinic Visit ◽  
Residual Volume ◽  
University Of Iowa ◽  
Home Dialysis ◽  
Dialysate Flow ◽  
Fill Volume ◽  
Tidal Peritoneal Dialysis

Objectives To determine the feasibility of home tidal peritoneal dialysis (TPD) and to assess whether eight hours of TPD can achieve uremia control and urea removal equal to that of continuous cycling peritoneal dialysis (CCPD). Design An open enrollment pilot study. Setting The Home Dialysis Training Center of the University of Iowa Hospitals and Clinics, a tertiary care teaching hospital. Patients Nine patients experienced with CCPD and living 80 km to 280 km from the dialysis center began TPD, because they wished to decrease their dialysis time. Interventions Following baseline measurements, each patient was taught to perform TPD. TPD consisted of an initial fill volume of 40 mL/kg, a residual volume approximately 20 mL/kg, and tidal exchanges of 10 to 20 mL/kg to achieve the desired hourly flow rate. Clinic assessments took place every four to six weeks, and prescriptions were subsequently altered to attain urea removal equal to that of CCPD. Measurements Patient interviews were used to determine TPD acceptance. Prior to each clinic visit, dialysate effluent volume and dialysis duration were recorded, and a sterile sample of the effluent was obtained for urea, creatinine, and total nitrogen measurement. Results Urea and creatinine clearances increased with dialysate flow. Dialysate nonurea nitrogen was 3.0 + 0.2 mmol/kg/D and changed minimally with increasing dialysate volumes. Eight hours of TPD (initial fill: 40 mL/ kg; residual volume: 20 mL/kg; tidal inflow: 20 mL/kg) with hourly tidal flow exceeding 40 mL/kg/hr and no daytime volume achieved urea removal equal to that of the patient's prior CCPD prescription. Conclusion TPD can provide dialysis equal to that of CCPD within a shorter amount of time (eight vs ten hours), but uses a greater volume of dialysate (16.0 L for TPD vs 9.5 L for CCPD).

scholarly journals Influence of exchange volume and dialysate flow rate on solute clearance in peritoneal dialysis

1978 ◽  
Vol 14 (5) ◽  
pp. 486-490 ◽  
Author(s):  
M. Robson ◽  
D.G. Oreopoulos ◽  
S. Izatt ◽  
R. Ogilvie ◽  
A. Rapoport ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Flow Rate ◽  
Dialysate Flow ◽  
Dialysate Flow Rate ◽  
Solute Clearance

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.

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.

Individualization of Exchange Volume

1984 ◽  
Vol 4 (2_suppl) ◽  
pp. 134-136 ◽  
Author(s):  
Zbylut J. Twardowski ◽  
LaVonne M. Burrows ◽  
Barbara F. Prowant
Keyword(s):  
Peritoneal Dialysis ◽  
Small Molecules ◽  
Small Molecule ◽  
High Volume ◽  
Dialysate Flow ◽  
Factors Associated ◽  
Large Molecular Weight ◽  
Dialysate Flow Rate ◽  
Poor Tolerance ◽  
Clinically Significant

This paper deals with adjustment of instillation volumes to achieve the best efficiency of dialysis in individual patients. Larger volumes may permit fewer daily exchanges which in turn decreases the number of connections and the risk of peritonitis. Factors associated with poor tolerance to increased volumes are discussed. Taller and heavier patients tolerate high volume dialysis better. It is generally accepted that most patients treated with continuous ambulatory peritoneal dialysis (CAPD) require an integrated (renal and dialysis) small molecule clearance of at least ten liters/day (7 ml/min). If dialysate concentration of small molecules equals that of plasma, a peritoneal dialysis clearance is tantamount to daily drainage volume. However, a wide variation in mass transfer has been observed among patients. Although this variation is more pronounced for large molecular weight solutes, the variation is also clinically significant for small molecules (1). In patients with small molecule dialysate concentration lower than that in plasma. the daily peritoneal clearance of ten liters can be achieved with dialysate flow rate exceeding this value and higher than ten liter drainage volumes per day may be required in some anuric patients.

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.

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