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Optimizing Automated Peritoneal Dialysis Using an Extended 3-Pore Model

Öberg, Carl M. LU and Rippe, Bengt LU (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.

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author
organization
publishing date
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 Inc.
external identifiers
  • scopus:85030148367
  • wos:000414048600019
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
2018-02-03 03:00:02
@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> &lt; 0.6), fast (peritoneal equilibrium test D/P<sub>crea</sub> &gt; 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 (&gt; 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},
  keyword      = {3-pore model,automated peritoneal dialysis,dialysis efficiency,PD prescription,urea kinetics},
  language     = {eng},
  month        = {09},
  number       = {5},
  pages        = {943--951},
  publisher    = {Elsevier Inc.},
  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},
  volume       = {2},
  year         = {2017},
}