Development of Computer-Aided Diagnostic System for Peritoneal Dialysis: NAVI LightTM

Abstract

Peritoneal dialysis, which is well-known as the renal replacement therapy, has been widely prescribed for the end stage renal disease in the world. With peritoneal dialysis, most of the patients that have preservation of the residual renal function achieve a dialysis outcome and ultrafiltration volume that is necessary to maintain their homeostasis. However, the therapeutic efficiency of the peritoneal dialysis decreases gradually over the duration of peritoneal dialysis treatment. Therefore, a monitoring of both the peritoneal permeability and dialysis outcome is indispensable to explore an optimal prescription and implement a long-term peritoneal dialysis. We developed a novel computer-aided diagnostic system for the peritoneal dialysis (NAVI LightTM) with employing both a kinetic mathematical model for peritoneal mass transfer and clinical test (NAVI test) which accumulates required clinical data. A set of unknown kinetic parameters on each patient were optimized by applying the clinical data to NAVI LightTM. To evaluate a validity of the parameter optimization, we statis-tically analyzed a relationship between the ultrafiltration vol-ume and MTACu/c which was the ratio of MTAC for urea to that for creatinine. Since MTACu/c showed a positive correla-tion with the ultrafiltration volume, NAVI LightTM could ana-lyze the peritoneal permeability of various therapeutic stages. Using NAVI LightTM, we estimated both the dialysis outcome and the ultrafiltation volume on the NAVI test, and analyzed a discrepancy between the estimated and the meas-ured data on the test. The estimated creatinine clearance, Kt/V for urea and ultrafiltration volume showed little discrepancy with measured those data. Moreover, those data on the ordinary prescription was also predicted by NAVI LightTM, which were compared with observed data on the ordinary prescription. The predicted those data also agreed with observed data. Therefore, these findings demonstrated that NAVI LightTM is useful for analysis of the peritoneal permeability and exploration of better prescription.