Continuous flow peritoneal dialysis: principles and applications

Continuous flow peritoneal dialysis (CFPD) is a technique of renal replacement therapy (RRT) dating back to the 1960s. Its essential features are a fixed intraperitoneal volume and rapid, continuous movement of dialysis solution into and out of the peritoneal cavity. Inlet and outlet catheters and a means of generating a large volume of sterile dialysate are required. External regeneration of dialysate via conventional hemodialysis (HD) equipment or sorbent technology mitigates the need for large volumes of sterile fluid and makes the technique feasible. Clearance depends on the peritoneal mass transfer coefficient, rate of dialysate flow, and efficiency of external regeneration. Studies to date all demonstrate small solute clearances three to eight times greater than conventional automated peritoneal dialysis (PD). Catheter design is crucial to the clinical success of the technique and will be discussed. Potential applications include daily home dialysis, treatment of acute renal failure in the intensive care unit (ICU), and ultrafiltration of ascites. Clinical experience with the latter will be presented in detail.