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Computer Simulations of Continuous Flow Peritoneal Dialysis Using the 3-Pore Model-A First Experience

Öberg, Carl M. LU and Martuseviciene, Giedre LU orcid (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.

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author
and
organization
publishing date
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] &lt; 0.6), fast (D/P crea &gt; 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 &gt; 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}},
}