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Ultrafiltration efficiency during automated peritoneal dialysis using glucose-based solutions.
Alp Akonur1, Clifford J Holmes, John K Leypoldt
1Renal Division, Baxter Healthcare Corporation, McGaw Park, Illinois 60085, USA. alp_akonur@baxter.com
Advances in Peritoneal Dialysis. Conference on Peritoneal Dialysis
|November 7, 2008
Summary
Ultrafiltration (UF) efficiency in peritoneal dialysis (PD) is higher with icodextrin during long dwells. For automated PD (APD), optimizing glucose concentration in short versus long dwells maximizes UF efficiency when icodextrin is unavailable.
Area of Science:
- Nephrology
- Biomedical Engineering
- Clinical Pharmacy
Background:
- Ultrafiltration (UF) efficiency in peritoneal dialysis (PD) is crucial for fluid management.
- Icodextrin solutions demonstrate higher UF efficiency during long dwells compared to glucose-based solutions.
- Understanding UF efficiency dynamics is key for optimizing PD therapy.
Purpose of the Study:
- To investigate UF efficiency in automated PD (APD) using the three-pore kinetic model.
- To compare UF efficiency between single long dwells and multiple short dwells in APD.
- To simulate and evaluate different APD prescription strategies for maximizing UF efficiency.
Main Methods:
- Utilized the three-pore kinetic model of PD transport.
- Simulated single long dwells and combinations of multiple short dwells during APD.
- Modeled two hypothetical APD prescriptions (A and B) with varying glucose concentrations and dwell times.
Main Results:
- Higher glucose concentrations and shorter dwell times increase UF efficiency per dwell.
- Simulations for a low-average transporter showed minimal difference in net UF between prescriptions.
- Total carbohydrate absorption was higher with high glucose in the long dwell, reducing overall UF efficiency.
Conclusions:
- The overall UF efficiency of the entire PD regimen must be considered in prescription.
- Icodextrin offers superior UF efficiency for long dwells.
- Maximizing APD UF efficiency without icodextrin involves higher glucose in short dwells and lower glucose in long dwells.
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