Computer Simulations of Continuous Flow Peritoneal Dialysis Using the 3-Pore Model-A First Experience
(2019) In Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis 39(3). p.236-242- Abstract
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... (More)
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.
(Less)
- author
- Öberg, Carl M. LU and Martuseviciene, Giedre LU
- organization
- publishing date
- 2019
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- automated peritoneal dialysis, dialysate flow rate, Metabolic cost
- in
- Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis
- volume
- 39
- issue
- 3
- pages
- 7 pages
- publisher
- Multimed Inc.
- external identifiers
-
- scopus:85066869586
- pmid:30846606
- ISSN
- 1718-4304
- DOI
- 10.3747/pdi.2018.00225
- language
- English
- LU publication?
- yes
- id
- 7a6321b7-24c4-4116-bee1-942c06643a19
- date added to LUP
- 2019-07-01 14:51:40
- date last changed
- 2024-03-19 16:50:06
@article{7a6321b7-24c4-4116-bee1-942c06643a19, abstract = {{<p>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.</p>}}, author = {{Öberg, Carl M. and Martuseviciene, Giedre}}, issn = {{1718-4304}}, keywords = {{automated peritoneal dialysis; dialysate flow rate; Metabolic cost}}, language = {{eng}}, number = {{3}}, pages = {{236--242}}, publisher = {{Multimed Inc.}}, series = {{Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis}}, title = {{Computer Simulations of Continuous Flow Peritoneal Dialysis Using the 3-Pore Model-A First Experience}}, url = {{http://dx.doi.org/10.3747/pdi.2018.00225}}, doi = {{10.3747/pdi.2018.00225}}, volume = {{39}}, year = {{2019}}, }