Continuous Flow Peritoneal Dialysis: A New Double Lumen Catheter

Abstract

Continuous flow peritoneal dialysis (CFPD) is a therapy originally utilized in the sixties. It was then abandoned because of technical reasons, but, today, a new interest in this technique is emerging, because of new technical solutions and new hardware capabilities. CFPD is a peritoneal dialysis technique in which a certain amount of fluid is maintained in the peritoneal cavity, while a continuous inflow and outflow is provided via twin catheters or through a double lumen catheter. In this paper a new double lumen catheter is presented. The catheter is characterized by the presence of a diffuser in the inflow lumen, while a standard coiled shape characterizes the outflow lumen. The diffuser allows the use of high dialysate flows without peritoneal damage and with an excellent distribution of the fluid. The other feature of the catheter is the removable hub which allows for an easy subcutaneous tunneling of the catheter with a subsequent connection to the y segment. The special shape also guarantees a minimum recirculation during treatment. Data obtained in the first implanted catheter showed a progressive increase in small solute clearances in relation to an increase of the flow and the tidal volume in the peritoneal cavity. In particular, urea clearances up to 48 ml/min and creatinine clearances up to 39 ml/min were obtained. No major complications were observed after one year of use of the catheter.

Peritoneal Dialysis for Acute Kidney Injury

“…Continuous flow peritoneal dialysis has been shown in chronic adult PD patients to increase the clearance of small solutes 3-to 8-fold and to significantly increase ultrafiltration compared to conventional PD (100)(101)(102). In one of the few studies of this dialysis technique in patients with AKI, Ponce et al used CFPD in two adult AKI patients and achieved a clearance similar to that reported with extracorporeal blood purification methods and an ultrafiltration rate of 200 -500 mL/h (45).…”

“…5 PDI rate of between 100 -300 mL/min and a glucose concentration of 1.5%. With this prescription, greatly improved ultrafiltration and clearances were obtained (100)(101)(102)(103). However, these studies were conducted with stable chronic PD patients.…”

Continuous Flow Peritoneal Dialysis

“…With two catheters, average urea clearances of 44 to 58 ml/min have been achieved (14,22,29) versus 14 to 20 ml/min with double lumen catheters (17,32). Recently Ronco et al (21,33) developed a new type of double lumen catheter with a diffuser to maximize mixing, whereby higher clearances can be achieved. In this study, we used the CFPD technique with two separate catheters instead of one double lumen catheter, because of the abovementioned better results and for the practical reason that the available double lumen catheters have to be placed surgically and are not available in pediatric sizes.…”

Principles and Operational Parameters to Optimize Poison Removal with Extracorporeal Treatments

“…Extremely high dialysate flows, provided by continuous‐flow PD over a short period of time, may allow good clearance of solutes that readily diffuse through the peritoneal membrane. For example, a urea clearance of 35 ml/minute was achieved when dialysate flow was 6–9 l/hour , and 48 ml/minute when using a double‐lumen catheter . In another study, methanol clearance was 70 ml/minute with a dialysate flow of 6 l/hour , a significant result but still minor compared with that obtained by IHD .…”