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Optimization of bimodal automated peritoneal dialysis prescription using the three-pore model

Öberg, Carl M. LU (2021) In Peritoneal Dialysis International 41(4). p.381-393
Abstract

Background: Previous studies suggested that automated peritoneal dialysis (APD) could be improved in terms of shorter treatment times and lower glucose absorption using bimodal treatment regimens, having ‘ultrafiltration (UF) cycles’ using a high glucose concentration and ‘clearance cycles’ using low or no glucose. The purpose of this study is to explore such regimes further using mathematical optimization techniques based on the three-pore model. Methods: A linear model with constraints is applied to find the shortest possible treatment time given a set of clinical treatment goals. For bimodal regimes, an exact analytical solution often exists which is herein used to construct optimal regimes giving the same Kt/V urea and/or weekly... (More)

Background: Previous studies suggested that automated peritoneal dialysis (APD) could be improved in terms of shorter treatment times and lower glucose absorption using bimodal treatment regimens, having ‘ultrafiltration (UF) cycles’ using a high glucose concentration and ‘clearance cycles’ using low or no glucose. The purpose of this study is to explore such regimes further using mathematical optimization techniques based on the three-pore model. Methods: A linear model with constraints is applied to find the shortest possible treatment time given a set of clinical treatment goals. For bimodal regimes, an exact analytical solution often exists which is herein used to construct optimal regimes giving the same Kt/V urea and/or weekly creatinine clearance and UF as a 6 × 2 L 1.36% glucose regime and an ‘adapted’ (2 × 1.5 L 1.36% + 3 × 3 L 1.36%) regime. Results: Compared to the non-optimized (standard and adapted regimes), the optimized regimens demonstrated marked reductions (>40%) in glucose absorption while having an identical weekly creatinine clearance (35 L) and UF (0.5 L). Larger fill volumes of 1200 mL/m2 (UF cycles) and 1400 mL/m2 (clearance cycles) can be used to shorten the total treatment time. Conclusion: These theoretical results imply substantial improvements in glucose absorption using optimized APD regimens while achieving similar water and solute removal as non-optimized APD regimens. While the current results are based on a well-established theoretical model for peritoneal dialysis, experimental and clinical studies need to be performed to validate the current findings.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Glucose sparing regimes, metabolic cost, optimized automated peritoneal dialysis, three-pore model
in
Peritoneal Dialysis International
volume
41
issue
4
pages
13 pages
publisher
Multimed Inc.
external identifiers
  • pmid:33910417
  • scopus:85105528117
ISSN
0896-8608
DOI
10.1177/08968608211010055
language
English
LU publication?
yes
id
5f908d39-4f20-44d9-8f8c-7803c364239f
date added to LUP
2021-06-02 15:22:46
date last changed
2025-01-26 11:13:09
@article{5f908d39-4f20-44d9-8f8c-7803c364239f,
  abstract     = {{<p>Background: Previous studies suggested that automated peritoneal dialysis (APD) could be improved in terms of shorter treatment times and lower glucose absorption using bimodal treatment regimens, having ‘ultrafiltration (UF) cycles’ using a high glucose concentration and ‘clearance cycles’ using low or no glucose. The purpose of this study is to explore such regimes further using mathematical optimization techniques based on the three-pore model. Methods: A linear model with constraints is applied to find the shortest possible treatment time given a set of clinical treatment goals. For bimodal regimes, an exact analytical solution often exists which is herein used to construct optimal regimes giving the same Kt/V urea and/or weekly creatinine clearance and UF as a 6 × 2 L 1.36% glucose regime and an ‘adapted’ (2 × 1.5 L 1.36% + 3 × 3 L 1.36%) regime. Results: Compared to the non-optimized (standard and adapted regimes), the optimized regimens demonstrated marked reductions (&gt;40%) in glucose absorption while having an identical weekly creatinine clearance (35 L) and UF (0.5 L). Larger fill volumes of 1200 mL/m<sup>2</sup> (UF cycles) and 1400 mL/m<sup>2</sup> (clearance cycles) can be used to shorten the total treatment time. Conclusion: These theoretical results imply substantial improvements in glucose absorption using optimized APD regimens while achieving similar water and solute removal as non-optimized APD regimens. While the current results are based on a well-established theoretical model for peritoneal dialysis, experimental and clinical studies need to be performed to validate the current findings.</p>}},
  author       = {{Öberg, Carl M.}},
  issn         = {{0896-8608}},
  keywords     = {{Glucose sparing regimes; metabolic cost; optimized automated peritoneal dialysis; three-pore model}},
  language     = {{eng}},
  month        = {{07}},
  number       = {{4}},
  pages        = {{381--393}},
  publisher    = {{Multimed Inc.}},
  series       = {{Peritoneal Dialysis International}},
  title        = {{Optimization of bimodal automated peritoneal dialysis prescription using the three-pore model}},
  url          = {{http://dx.doi.org/10.1177/08968608211010055}},
  doi          = {{10.1177/08968608211010055}},
  volume       = {{41}},
  year         = {{2021}},
}