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Tidal peritoneal dialysis: kinetics and protein balance
M J Flanigan1, V S Lim, T A Pflederer
1Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City.
Summary
Tidal peritoneal dialysis (TPD) can effectively manage blood urea nitrogen levels in patients on home dialysis. This study shows TPD maintains urea nitrogen below 60 mg/dL with a protein intake of 1.2 g/kg/d.
Area of Science:
- Nephrology
- Renal Replacement Therapy
- Dialysis Technology
Background:
- Automated peritoneal dialysis (APD) is preferred by some patients but can be time-consuming.
- APD prescriptions may hinder patient rehabilitation.
- Continuous ambulatory peritoneal dialysis (CAPD) is a common alternative.
Purpose of the Study:
- To evaluate an 8-hour tidal peritoneal dialysis (TPD) prescription.
- To determine if TPD can maintain time-averaged blood urea nitrogen ≤ 60 mg/dL.
- To assess TPD efficacy with a protein intake of approximately 1.2 g/kg/day.
Main Methods:
- Metabolic balance study in 10 home dialysis patients.
- Peritoneal equilibration tests to derive mass transfer area coefficients (MTaCs).
- Nitrogen balance measurements during TPD with a controlled diet.
Main Results:
- TPD urea and creatinine clearances were predictable using MTaC values (r²=0.70 urea, r²=0.91 creatinine).
- Dietary protein intake correlated with urea nitrogen generation during TPD (r²=0.82).
- TPD with Kt/V(urea) ≈ 2.1 maintained time-averaged blood urea nitrogen ≈ 60 mg/dL at the specified protein intake.
Conclusions:
- TPD is a viable option for home dialysis patients.
- TPD prescriptions can be optimized using MTaC values.
- TPD effectively manages urea levels, potentially aiding rehabilitation.