scholarly journals Relationship between body size, fill volume, and mass transfer area coefficient in peritoneal dialysis.

1994 ◽  
Vol 4 (10) ◽  
pp. 1820-1826 ◽  
Author(s):  
P Keshaviah ◽  
P F Emerson ◽  
E F Vonesh ◽  
J C Brandes
Keyword(s):  
Mass Transfer ◽  
Peritoneal Dialysis ◽  
Body Size ◽  
Body Surface ◽  
Time Profiles ◽  
Surface Areas ◽  
Concentration Time ◽  
Fill Volume ◽  
Dialysate Volume ◽  
Tidal Peritoneal Dialysis

A peritoneal dialysate fill volume of 2 L has become the standard of clinical practice, but the relationships between body size, fill volume, and mass transfer area coefficient (KoA) have not been well established. These relationships were studied in 10 stable peritoneal dialysis patients who underwent six peritoneal equilibration studies (2 h each) at fill volumes of 0.5, 1, 1.5, 2, 2.5, and 3 L. The concentration-time profiles for urea, creatinine, and glucose were measured at each fill volume, and residual volumes were calculated from the preceding dwell period. A modified Henderson equation was used to calculate the KoA for the three solutes as a function of fill volume. By normalizing the KoA for each solute to the value at 2 L, the data for all three solutes collapsed onto the same trend line when plotting the normalized KoA versus dialysate volume. Between 0.5- and 2-L fill volumes, the average normalized KoA increases in an almost linear fashion, its value almost doubling over this range. Between 2- and 3-L fill volumes, there is less than a 10% change in the normalized KoA. However, fill volumes for peak urea KoA were found to increase with increasing body surface area (R = 0.76), being around 2.5 L for an average-sized patient and increasing to between 3 and 3.5 L for body surface areas > 2 m2. To maximize solute transport, these relationships between body size, volume, and KoA should be considered when choosing fill volumes for continuous ambulatory peritoneal dialysis and automated peritoneal dialysis and when deciding reserve and tidal volumes for tidal peritoneal dialysis.

Relationship between Fill Volume, Intraperitoneal Pressure, Body Size, and Subjective Discomfort Perception in CAPD Patients

2000 ◽  
Vol 20 (2) ◽  
pp. 188-193 ◽  
Author(s):  
María De Jesús Ventura ◽  
Dante Amato ◽  
Ricardo Correa–Rotter ◽  
Ramón Paniagua ◽  
Keyword(s):  
Peritoneal Dialysis ◽  
Body Size ◽  
Random Order ◽  
Immunosuppressive Drugs ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Intraperitoneal Pressure ◽  
Fill Volume ◽  
Subjective Discomfort ◽  
Dialysate Volume

Objective To determine changes in intraperitoneal pressure (IPP) when dialysate fill volume is increased from 2.0 L to 2.5 L to 3.0 L per exchange, and to evaluate the relationship with subjective discomfort perception. Design Cross-sectional survey. Setting Seven Mexican hospital-based dialysis centers. Patients Eighty-one adult patients on continuous ambulatory peritoneal dialysis (CAPD) without restriction criteria for age, gender, or time on dialysis, were studied. Patients seropositive for HIV or hepatitis B, and those with cancer or receiving immunosuppressive drugs were excluded. Participants were studied as outpatients. Main Measures Blindly and in random order, 2.0-, 2.5-, and 3.0-L volumes of dialysate were infused consecutively. Body surface area (BSA) was calculated from patient height and weight. IPP was assessed with the patient lying supine, measuring the height of the dialysate column inside the peritoneal dialysis bag tubing. Blood pressure and subjective discomfort perception (using a visual analog scale of 0 – -100 mm) were also evaluated and registered after each of the three exchanges. Results The IPP rose with each increase of dialysate volume and was higher in males than in females for each fill volume level. For males IPP was 18.9 ± 6.9, 20.8 ± 7.1, and 22.9 ± 7.5 cm H2O; and for females it was 16.5 ± 5.7, 18.4 ± 5.5, and 19.7 ± 6.2 cm H2O for 2.0-, 2.5-, and 3.0-L fill volumes respectively ( p < 0.01 among fill volumes and between genders). Intraperitoneal pressure showed significant negative correlation with the fill volume corrected for patient body size as reflected by the dialysate volume/ BSA ratio ( r = –0.393, p < 0.01; r = 0.319, p < 0.01; and r = –0.274, p < 0.02 for 2.0-, 2.5-, and 3.0-L fill volumes respectively). Discomfort score rose as fill volume rose, with a median of 0, 2.5, and 13.0 for 2.0-, 2.5-, and 3.0-L fill volumes respectively ( p < 0.001). It is interesting, however, that with 2.5-L and 3.0-L dialysate infusion volumes, 64% and 44% of the patients, respectively, had no discomfort at all. Conclusion Dialysate volume increase is associated with higher IPP, which is modulated by the gender and body size of the patients. Although the mean discomfort score was higher with larger dialysate volumes, there was no significant correlation between discomfort and IPP or the dialysate volume/BSA ratio. Many patients had no discomfort with 2.5-L or even with 3.0-L dialysate infusions; theoretically, they can be treated with larger volumes.

Symptomatic Peritoneal Calcification in a Child: Treatment with Tidal Peritoneal Dialysis

1994 ◽  
Vol 14 (1) ◽  
pp. 26-29 ◽  
Author(s):  
Bradley A. Warady ◽  
Vicki Bahl ◽  
Uri Alan ◽  
Stanley Hellerstein
Keyword(s):  
Abdominal Pain ◽  
Peritoneal Dialysis ◽  
Symptomatic Relief ◽  
Duration Of Treatment ◽  
Child Treatment ◽  
Dialysis Unit ◽  
Case Evaluation ◽  
Fill Volume ◽  
Unique Approach ◽  
Tidal Peritoneal Dialysis

Objective To evaluate the ability of tidal peritoneal dialysis to decrease the pain and frequency of hemoperitoneum associated with peritoneal calcification. Design Prospective case evaluation. Setting The Home Peritoneal Dialysis Unit, Children's Mercy Hospital. Patient Seven-year-old male with diffuse peritoneal calcifications, daily abdominal pain, and recurrent hemoperitoneum. Intervention Tidal peritoneal dialysis was conducted with an initial fill volume of 45 mL/kg and a tidal inflow volume of 23 mL/kg. The patient also maintained a daytime pass volume of 45 mL/kg. Duration of treatment was 7 months. Results The patient's abdominal pain resolved 2 days after initiating tidal peritoneal dialysis. No episodes of hemoperitoneum or abdominal pain have occurred for 7 months. Conclusion Tidal peritoneal dialysis is a unique approach to the achievement of symptomatic relief in the patient with peritoneal calcification.

Urea is the Best Molecule to Target Adequacy of Peritoneal Dialysis

2000 ◽  
Vol 20 (2_suppl) ◽  
pp. 58-64 ◽  
Author(s):  
Frank A. Gotch
Keyword(s):  
Peritoneal Dialysis ◽  
Body Surface ◽  
Residual Renal Function ◽  
Dialysis Dose ◽  
Surface Areas ◽  
Wide Range ◽  
Anephric Patients ◽  
Dialysis Outcomes ◽  
Two Parameters ◽  
Urea Distribution Volume

For hemodialysis, a large base of data shows the validity of modelling the dialysis dose and reliably estimating protein intake from equilibrated Kt/V urea (eKt/VU), the total dialyzer urea clearance provided during each treatment divided by the urea distribution volume. An eKt/VU of 1.05 thrice weekly is judged adequate, but is still under study. In continuous ambulatory peritoneal dialysis (CAPD), two dosage criteria are widely recognized: continuous (“standard”) Kt/VU (stdKt/VU = 2.0 weekly), and total creatinine (Cr) clearance normalized to body surface area (KCrT = 70 L/week/1.73 m2). The CANUSA study concluded that a stdKt/VU of 2.1 and a KCrT of 70 L/week/1.73 m2 gave equivalent clinical outcomes. The Dialysis Outcomes Quality Initiative (DOQI) recommends values of 2.0 and 60 L/ week/1.73 m2 respectively. An analysis of these two parameters for males and females over a wide range of body surface areas (BSAs) was done and the analysis showed: ( 1 ) The U and Cr dose criteria are incommensurable—that is, they can virtually never be achieved simultaneously in anephric patients. ( 2 ) The Cr criterion varies widely with the sex of the patient and with the BSA-dependent variation in stdKt/VU over a range of 2.1 to 3.0. ( 3 ) The U criterion always produces a KCrT < 60 L/week/1.73 m2 in females and 60 – 70 L/ week/1.73 m2 in males. With respect to U and Cr, the CANUSA results were concluded to be valid in patients with substantial residual renal function, but probably not applicable to anephric patients where the doses are clearly incommensurable.

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).

Impact of Fill Volume on Peritoneal Clearances and Cytokine Appearance in Peritoneal Dialysis

2004 ◽  
Vol 24 (2) ◽  
pp. 156-162 ◽  
Author(s):  
Ramón Paniagua ◽  
María de Jesús Ventura ◽  
Ernesto Rodríguez ◽  
Juana Sil ◽  
Teresa Galindo ◽  
...  
Keyword(s):  
Fluid Dynamics ◽  
Peritoneal Dialysis ◽  
Interleukin 6 ◽  
Fluid Absorption ◽  
Necrosis Factor Alpha ◽  
Intraperitoneal Pressure ◽  
Fill Volume ◽  
Dialysate Volume ◽  
Small Solute ◽  
Solute Clearance

Background Current adequacy guidelines for peritoneal dialysis encourage the use of large fill volumes for the attainment of small solute clearance targets. These guidelines have influenced clinical practice in a significant way, and adoption of higher fill volumes has become common in North America. Several studies, however, have challenged the relevance of increasing small solute clearance; this practice may result in untoward consequences in patients. Objective The present study was designed to explore the relationship between dialysate volume and the clearance of different sized molecules, fluid dynamics, and appearance of peritoneal cytokines. Methods Thirteen adult prevalent patients on continuous ambulatory peritoneal dialysis were studied. Three different dialysate volumes (2.0, 2.5, and 3.0 L) were infused on consecutive days in a random order. Several measurements of peritoneal fluid dynamics (intraperitoneal pressure, net ultrafiltration, fluid absorption), solute clearances (urea, creatinine, β2-microglobulin, albumin, IgG, and transferrin), and appearance of interleukin-6 and tumor necrosis factor alpha (TNFα) were assessed. Results Increase in dialysate fill volume (from 2 to 2.5 to 3 L) was examined in relationship to body surface area (BSA). The dialysate volume/BSA (DV/BSA) ratio increased from 1262 to 1566 to 1871 mL/m2 on 2.0, 2.5, and 3.0 L dialysate volumes, respectively. In parallel, diastolic blood pressure increased from 82.7 ± 8.8 to 87.0 ± 9.5 to 92 ± 8.3 mmHg ( p < 0.05). Net ultrafiltration rate also increased, from 0.46 ± 0.48 to 0.72 ± 0.42 to 0.97 ± 0.49 mL/minute ( p < 0.01), despite a concomitant increase in fluid absorption, from 1.05 ± 0.34 to 1.21 ± 0.40 to 1.56 ± 0.22 mL/min ( p < 0.01). Urea peritoneal clearance increased from 8.27 ± 0.68 to 9.92 ± 1.6 to 12.98 ± 4.03 mL/min ( p < 0.01); creatinine peritoneal clearance increased from 6.69 ± 1.01 to 7.64 ± 1.12 to 8.69 ± 1.76 mL/min ( p < 0.01). Clearance of the other measured molecules did not change. Appearance of interleukin-6 increased 17% and 43% ( p < 0.01), and TNFα appearance increased 14% and 50% ( p < 0.01) when dialysate volumes of 2.5 and 3.0 L were used, compared with 2.0 L. Conclusions These results show that, with higher values of DV/BSA ratio, small solute peritoneal clearance is increased, but clearances of large molecules remain unchanged. With the use of higher volumes, fluid absorption rate and the appearance of proinflammatory cytokines in the dialysate are increased.

Intraperitoneal vancomycin for peritoneal dialysis-associated peritonitis in children: Evaluation of loading dose guidelines

2020 ◽  
pp. 089686082095092
Author(s):  
Kathleen Hennessy ◽  
Edmund V Capparelli ◽  
Gale Romanowski ◽  
Lawrence Alejandro ◽  
William Murray ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Adverse Effects ◽  
Body Surface ◽  
First Generation ◽  
Pediatric Patients ◽  
Generation Cephalosporin ◽  
Loading Dose ◽  
Population Pk ◽  
Dosing Strategies ◽  
Dialysate Volume

Background: Current pediatric International Society for Peritoneal Dialysis guidelines for initial treatment of peritoneal dialysis (PD)-associated peritonitis suggest either monotherapy with cefepime or double therapy with first-generation cephalosporin or glycopeptide and ceftazidime or aminoglycoside. When using vancomycin, the intraperitoneal (IP) recommended pediatric loading dosage is 1000 mg/L of dialysate. This is based on adult pharmacokinetic (PK) studies and roughly translates to the adult recommendation where 30 mg/kg in 2 L is approximately 1000 mg/L. However, since the dialysate volume in pediatric patients is normalized to body surface area and not weight, the current recommended dosing can result in high vancomycin exposure in children. Vancomycin can potentially cause adverse effects. We aimed to determine if the IP vancomycin dosing of 1000 mg/L was causing elevated vancomycin levels and to offer possible dosing recommendations based on PK modeling and simulation. Methods: Retrospective review of pediatric patients who had been treated with IP vancomycin for PD-associated peritonitis. Vancomycin levels obtained for clinical monitoring were analyzed using NONMEM to generate population and individual (empiric Bayesian) estimates of vancomycin PK parameters and estimated peak levels. Predicted vancomycin peaks were also simulated from virtual pediatrics patients 3–70 kg following various dosing strategies. Results: Six episodes of peritonitis in three patients were analyzed. In the two episodes treated with 1000 mg/L, the first vancomycin levels (h post) were 95.6 ug/mL (3) and 49 (33) and following 500 mg/L were 33.2 (11), 30.2 (11), 23.6 (24), and 22.1 (11). All patients were cured of their peritonitis without the need for catheter removal. Based on our population PK model, a 1000 mg/L IP vancomycin loading dose will typically result in peak > 50 mg/L in patients weighing <35 kg and >60 mg/L in patients <15 kg. Vancomycin levels will remain above 20 mg/L for over 2 days without additional vancomycin dosing. Conclusion: The data suggest that a loading dose of vancomycin 1000 mg/L leads to higher than desired vancomycin levels and should be lowered. A 500 mg/L loading dosing appears more appropriate and needs further study.

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.

Nitrate and chloride formation in chloramination

1994 ◽  
Vol 30 (9) ◽  
pp. 101-110
Author(s):  
V. Diyamandoglu
Keyword(s):  
Kinetic Model ◽  
Analytical Method ◽  
Kinetic Data ◽  
Experimental Results ◽  
Mass Balances ◽  
Time Profiles ◽  
Slow Decay ◽  
Concentration Time ◽  
End Products ◽  
Chlorine Residuals

The formation of nitrate and chloride as end-products of chloramination (combined chlorination) was investigated at pH ranging between 6.9 and 9.6 at 25°C. The experimental results comprised concentration-time profiles of combined chlorine residuals along with nitrate and chloride. Nitrite, if present, was always below the detectibility limit of the analytical method used (25 ppb). Mass balances on chlorine species depicted that chloride formed during the slow decay of combined chlorine residuals does not account for all the chlorine lost. This substantiates the formation of other reaction end-products which are yet to be identified. A kinetic model for chloramination is proposed based on the kinetic data obtained in this study.

The Effect of Changes in Dialysate Volume on Glucose and Urea Equilibration

1994 ◽  
Vol 14 (3) ◽  
pp. 236-239 ◽  
Author(s):  
Edward C. Kohaut ◽  
F. Bryson Waldo ◽  
Mark R. Benfield
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Prospective Study ◽  
Body Surface ◽  
Patient Population ◽  
Different Ages ◽  
Student’S T ◽  
A Prospective Study ◽  
Dialysate Volume ◽  
Student’S T Test

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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