Abstract
A system for sorbent-assisted peritoneal dialysis (SAPD) was designed to continuously recirculate dialysate via a tidal mode using a single lumen peritoneal catheter with regeneration of spent dialysate by means of sorbent technology. We hypothesize that SAPD treatment will maintain a high plasma-to-dialysate concentration gradient and increase the mass transfer area coefficient of solutes. Thereby, the SAPD system may enhance clearance while reducing the number of exchanges. Application is envisaged at night as a bedside device (12 kg, nighttime system). A wearable system (2.0 kg, daytime system) may further enhance clearance during the day. Urea, creatinine, and phosphate removal were studied with the daytime and nighttime system (n = 3 per system) by recirculating 2 liters of spent peritoneal dialysate via a tidal mode (mean flow rate: 50 and 100 mL/min, respectively) for 8 h in vitro. Time-averaged plasma clearance over 24 h was modeled assuming one 2 liter exchange/day, an increase in mass transfer area coefficient, and 0.9 liters ultrafiltration/day. Urea, creatinine, and phosphate removal was 33.2 ± 4.1, 5.3 ± 0.5, and 6.2 ± 1.8 mmol, respectively, with the daytime system and 204 ± 28, 10.3 ± 2.4, and 11.4 ± 2.1 mmol, respectively, with the nighttime system. Time-averaged plasma clearances of urea, creatinine and phosphate were 9.6 ± 1.1, 9.6 ± 1.7, and 7.0 ± 0.9 mL/min, respectively, with the nighttime system and 10.8 ± 1.1, 13.4 ± 1.8, and 9.7 ± 1.6 mL/min, respectively, with the daytime and nighttime system. SAPD treatment may improve removal of uremic toxins compared with conventional peritoneal dialysis, provided that peritoneal mass transport will increase.
Highlights
Worldwide, ~3.4 million patients receive life-sustaining dialysis treatment, of which ~88% are treated with in-center hemodialysis (HD) and ~11% are treated with peritoneal dialysis (PD) at home [17]
PD has several advantages compared with HD, such as a survival advantage during the early years of dialysis [28], prolonged maintenance of residual kidney function [23, 25, 30], and a blood-free access, it has several important disadvantages such as a relatively low clearance [6, 7, 14] and limited technique survival due to structural and functional deterioration of the peritoneal membrane as a result of the high incidence of recurrent peritonitis [31] and chronic exposure to hypertonic glucose-based dialysis solutions [46]
Base and glucose release by the nighttime system were evaluated in the single-pass configuration to maintain constant solute concentrations in dialysate entering the sorbent-assisted PD (SAPD) system, simulating equilibration of the intraperitoneal and intravascular compartment in vivo (Table 4)
Summary
Worldwide, ~3.4 million patients receive life-sustaining dialysis treatment, of which ~88% are treated with in-center hemodialysis (HD) and ~11% are treated with peritoneal dialysis (PD) at home [17]. In both PD and HD, removal of waste solutes and excess water is inadequate, contributing to severe health problems, high mortality [15᎑20% per year [15]], and poor quality of life [1]. PD has several advantages compared with HD, such as a survival advantage during the early years of dialysis [28], prolonged maintenance of residual kidney function [23, 25, 30], and a blood-free access, it has several important disadvantages such as a relatively low clearance [6, 7, 14] and limited technique survival due to structural and functional deterioration of the peritoneal membrane as a result of the high incidence of recurrent peritonitis [31] and chronic exposure to hypertonic glucose-based dialysis solutions [46]. With conventional PD, the diffusion rate of toxins across the peritoneal membrane decreases during a static dwell due to equilibration of the intraperitoneal fluid with plasma
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