Optimizing Automated Peritoneal Dialysis Using an Extended 3-Pore Model
(2017) In Kidney International Reports 2(5). p.943-951- Abstract
Introduction In the current study, an extended 3-pore model (TPM) is presented and applied to the problem of optimizing automated peritoneal dialysis (APD) with regard to osmotic water transport (UF), small/middle-molecule clearance, and glucose absorption. Methods Simulations were performed for either intermittent APD (IPD) or tidal APD (TPD). IPD was simulated for fill and drain volumes of 2 L, whereas TPD was simulated using a tidal volume of 0.5 L, 1 L, or 1.5 L with full drains and subsequent fills (2 L) occurring after every fifth dwell. A total of 25 cycles for a large number of different dialysate flow rates (DFR) were simulated using 3 different glucose concentrations (1.36%, 2.27%, and 3.86%) and 3 different peritoneal... (More)
Introduction In the current study, an extended 3-pore model (TPM) is presented and applied to the problem of optimizing automated peritoneal dialysis (APD) with regard to osmotic water transport (UF), small/middle-molecule clearance, and glucose absorption. Methods Simulations were performed for either intermittent APD (IPD) or tidal APD (TPD). IPD was simulated for fill and drain volumes of 2 L, whereas TPD was simulated using a tidal volume of 0.5 L, 1 L, or 1.5 L with full drains and subsequent fills (2 L) occurring after every fifth dwell. A total of 25 cycles for a large number of different dialysate flow rates (DFR) were simulated using 3 different glucose concentrations (1.36%, 2.27%, and 3.86%) and 3 different peritoneal transport types: slow (peritoneal equilibrium test D/Pcrea < 0.6), fast (peritoneal equilibrium test D/Pcrea > 0.8), and average. Solute clearance and UF were simulated to occur during the entire dwell, including both fill and drain periods. Results It is demonstrated that DFRs exceeding ∼ 3 L/h are of little benefit both for UF and small-solute transport, whereas middle-molecule clearance is enhanced at higher DFRs. The simulations predict that large reductions (> 20%) in glucose absorption are possible by using moderately higher DFRs than a standard 6 × 2 L prescription and by using shorter optimized “bi-modal” APD regimens that alternate between a glucose-free solution and a glucose-containing solution. Discussion Reductions in glucose absorption appear to be significant with the proposed regimens for APD; however, further research is needed to assess the feasibility and safety of these regimens.
(Less)
- author
- Öberg, Carl M. LU and Rippe, Bengt LU
- organization
- publishing date
- 2017-09-01
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- 3-pore model, automated peritoneal dialysis, dialysis efficiency, PD prescription, urea kinetics
- in
- Kidney International Reports
- volume
- 2
- issue
- 5
- pages
- 9 pages
- publisher
- Elsevier
- external identifiers
-
- scopus:85030148367
- wos:000414048600019
- pmid:29270500
- ISSN
- 2468-0249
- DOI
- 10.1016/j.ekir.2017.04.010
- language
- English
- LU publication?
- yes
- id
- bb14bbce-e35f-45a4-819c-1f74ab6838df
- date added to LUP
- 2017-11-03 07:44:42
- date last changed
- 2024-08-20 08:39:09
@article{bb14bbce-e35f-45a4-819c-1f74ab6838df, abstract = {{<p>Introduction In the current study, an extended 3-pore model (TPM) is presented and applied to the problem of optimizing automated peritoneal dialysis (APD) with regard to osmotic water transport (UF), small/middle-molecule clearance, and glucose absorption. Methods Simulations were performed for either intermittent APD (IPD) or tidal APD (TPD). IPD was simulated for fill and drain volumes of 2 L, whereas TPD was simulated using a tidal volume of 0.5 L, 1 L, or 1.5 L with full drains and subsequent fills (2 L) occurring after every fifth dwell. A total of 25 cycles for a large number of different dialysate flow rates (DFR) were simulated using 3 different glucose concentrations (1.36%, 2.27%, and 3.86%) and 3 different peritoneal transport types: slow (peritoneal equilibrium test D/P<sub>crea</sub> < 0.6), fast (peritoneal equilibrium test D/P<sub>crea</sub> > 0.8), and average. Solute clearance and UF were simulated to occur during the entire dwell, including both fill and drain periods. Results It is demonstrated that DFRs exceeding ∼ 3 L/h are of little benefit both for UF and small-solute transport, whereas middle-molecule clearance is enhanced at higher DFRs. The simulations predict that large reductions (> 20%) in glucose absorption are possible by using moderately higher DFRs than a standard 6 × 2 L prescription and by using shorter optimized “bi-modal” APD regimens that alternate between a glucose-free solution and a glucose-containing solution. Discussion Reductions in glucose absorption appear to be significant with the proposed regimens for APD; however, further research is needed to assess the feasibility and safety of these regimens.</p>}}, author = {{Öberg, Carl M. and Rippe, Bengt}}, issn = {{2468-0249}}, keywords = {{3-pore model; automated peritoneal dialysis; dialysis efficiency; PD prescription; urea kinetics}}, language = {{eng}}, month = {{09}}, number = {{5}}, pages = {{943--951}}, publisher = {{Elsevier}}, series = {{Kidney International Reports}}, title = {{Optimizing Automated Peritoneal Dialysis Using an Extended 3-Pore Model}}, url = {{http://dx.doi.org/10.1016/j.ekir.2017.04.010}}, doi = {{10.1016/j.ekir.2017.04.010}}, volume = {{2}}, year = {{2017}}, }