Abstract
Water removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM). We analysed ultrafiltration patterns during night APD following a dry day (APDDD; no daytime fluid exchange) or wet day (APDWD; daytime exchange). Ultrafiltration for each APD exchange were recorded for 16 days using RPM in 14 patients. The distributed model of fluid and solute transport was applied to simulate APD and to explore the impact of changes in peritoneal tissue hydration on ultrafiltration. We found lower ultrafiltration (mL, median [first quartile, third quartile]) during first and second vs. consecutive exchanges in APDDD (−61 [−148, 27], 170 [78, 228] vs. 213 [126, 275] mL; p < 0.001), but not in APDWD (81 [−8, 176], 81 [−4, 192] vs. 115 [4, 219] mL; NS). Simulations in a virtual patient showed that lower ultrafiltration (by 114 mL) was related to increased peritoneal tissue hydration caused by inflow of 187 mL of water during the first APDDD exchange. The observed phenomenon of lower ultrafiltration during initial exchanges of dialysis fluid in patients undergoing APDDD appears to be due to water inflow into the peritoneal tissue, re-establishing a state of increased hydration typical for peritoneal dialysis.
Highlights
Water removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM)
Our analysis of UF data delivered by RPM in APD patients treated at home revealed lower net UF during the first cycle of APD session in patients using a dry day regime (APDDD) as compared to those on a wet day regime (APDWD); and some APDDD patients had negative net UF during the first APD exchange
Peritoneal transport modelling indicated that a likely explanation for this phenomenon is that the daytime exchange influenced the hydration state of the peritoneal membrane and that this affected water removal during the initial exchange(s) of the subsequent APD session
Summary
Water removal which is a key treatment goal of automated peritoneal dialysis (APD) can be assessed cycle-by-cycle using remote patient monitoring (RPM). Net ultrafiltration—which is a function of transcapillary ultrafiltration, driven by the osmotic force induced by hypertonic dialysis fluid, and water reabsorption from the peritoneal cavity—is influenced by factors such as infused volume, the effective peritoneal surface area in contact with dialysis fluid and exposure time of dialysis fluid in full contact with the peritoneal membrane. These factors vary considerably in automated peritoneal dialysis (APD). Clinical characteristics Sex, women/men Age, years Body weight, kg Diastolic blood pressure, mmHg Systolic blood pressure, mmHg PET D/Pcreat Dialysis vintage, months Diuresis, mL
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