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IS ADAPTED APD THEORETICALLY MORE EFFICIENT THAN CONVENTIONAL APD?

Rippe, Bengt LU and Öberg, Carl LU (2016) In Peritoneal Dialysis International
Abstract
♦ Background: A modified version of automated peritoneal dialysis (APD) using not only variable dwell times but also variable fill volumes has been tested against conventional APD (cAPD) with fixed dwell volumes in a randomized controlled clinical study. The results have indicated that the modified schedule for APD, denoted adapted APD (aAPD), can lead to improved small solute clearances, and, above all, a markedly increased sodium removal (NaR). To theoretically test these results, we have modeled aAPD vs cAPD in computer simulations using the 3-pore model (TPM). ♦ Methods: The TPM, modified by including a transient, initial inflation of small solute mass transfer area coefficients (PS values), was employed. For simulations of osmotic... (More)
♦ Background: A modified version of automated peritoneal dialysis (APD) using not only variable dwell times but also variable fill volumes has been tested against conventional APD (cAPD) with fixed dwell volumes in a randomized controlled clinical study. The results have indicated that the modified schedule for APD, denoted adapted APD (aAPD), can lead to improved small solute clearances, and, above all, a markedly increased sodium removal (NaR). To theoretically test these results, we have modeled aAPD vs cAPD in computer simulations using the 3-pore model (TPM). ♦ Methods: The TPM, modified by including a transient, initial inflation of small solute mass transfer area coefficients (PS values), was employed. For simulations of osmotic ultrafiltration (UF), the TPM uses a constantly inflated value for PS for glucose and also a reduced value for PS for Na+, setting the peritoneal lymphatic reabsorption term at 0.3 mL/min. The simulations were performed by assuming that increases in intraperitoneal hydrostatic pressure (IPP) are transmitted to the capillary level (via vein compression) and therefore do not significantly affect the Starling balance. Furthermore, the effective peritoneal surface area (A) was set to be variable as a function of intraperitoneal volume (IPV). ♦ Results: The simulations demonstrated a minor improvement of small solute clearances (~0.7 - 1.6%) and a very small improvement of UF and NaR in aAPD compared to cAPD. ♦ Conclusions: Due mainly to the increased fill volumes in 3 out of 5 dwells in aAPD, this modality caused minor increases in small solute clearances and marginal effects on UF and NaR. The computer simulations point to a need for accurate sodium determinations in aAPD, considering all the methodological problems and pitfalls relevant to determining dialysate Na+ concentrations and peritoneal sodium mass balance. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Peritoneal Dialysis International
publisher
Multimed Inc.
external identifiers
  • PMID:26847586
ISSN
1718-4304
DOI
10.3747/pdi.2015.00144
language
English
LU publication?
yes
id
1c43ac19-0703-463e-8239-a4b1e9e0e28c (old id 8829239)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/26847586?dopt=Abstract
date added to LUP
2016-03-02 09:29:41
date last changed
2016-11-09 15:40:34
@misc{1c43ac19-0703-463e-8239-a4b1e9e0e28c,
  abstract     = {♦ Background: A modified version of automated peritoneal dialysis (APD) using not only variable dwell times but also variable fill volumes has been tested against conventional APD (cAPD) with fixed dwell volumes in a randomized controlled clinical study. The results have indicated that the modified schedule for APD, denoted adapted APD (aAPD), can lead to improved small solute clearances, and, above all, a markedly increased sodium removal (NaR). To theoretically test these results, we have modeled aAPD vs cAPD in computer simulations using the 3-pore model (TPM). ♦ Methods: The TPM, modified by including a transient, initial inflation of small solute mass transfer area coefficients (PS values), was employed. For simulations of osmotic ultrafiltration (UF), the TPM uses a constantly inflated value for PS for glucose and also a reduced value for PS for Na+, setting the peritoneal lymphatic reabsorption term at 0.3 mL/min. The simulations were performed by assuming that increases in intraperitoneal hydrostatic pressure (IPP) are transmitted to the capillary level (via vein compression) and therefore do not significantly affect the Starling balance. Furthermore, the effective peritoneal surface area (A) was set to be variable as a function of intraperitoneal volume (IPV). ♦ Results: The simulations demonstrated a minor improvement of small solute clearances (~0.7 - 1.6%) and a very small improvement of UF and NaR in aAPD compared to cAPD. ♦ Conclusions: Due mainly to the increased fill volumes in 3 out of 5 dwells in aAPD, this modality caused minor increases in small solute clearances and marginal effects on UF and NaR. The computer simulations point to a need for accurate sodium determinations in aAPD, considering all the methodological problems and pitfalls relevant to determining dialysate Na+ concentrations and peritoneal sodium mass balance.},
  author       = {Rippe, Bengt and Öberg, Carl},
  issn         = {1718-4304},
  language     = {eng},
  month        = {02},
  publisher    = {ARRAY(0x957b330)},
  series       = {Peritoneal Dialysis International},
  title        = {IS ADAPTED APD THEORETICALLY MORE EFFICIENT THAN CONVENTIONAL APD?},
  url          = {http://dx.doi.org/10.3747/pdi.2015.00144},
  year         = {2016},
}