Continuous flow peritoneal dialysis (CFPD) improves ultrafiltration in children with acute kidney injury on conventional PD using a 4.25 % dextrose solution

Nourse, Peter; Sinclair, Gina; Gajjar, Priya; Plessis, Mandi du; Argent, Andrew C.

doi:10.1007/s00467-016-3341-5

Cited by 14 publications

(15 citation statements)

References 11 publications

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“…In a recent study (3), Nourse and colleagues compared conventional (intermittent) PD and CFPD in infants and found creatinine and urea clearances as well as UF rates to be nearly 3 times higher with CFPD, despite quite a small fill volume. In their study, the drain rate was set slightly higher (102.5 mL/ min) than the inflow rate (100 mL/min) to account for the UF rate and to prevent overfill.…”

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confidence: 99%

Computer Simulations of Continuous Flow Peritoneal Dialysis Using the 3-Pore Model—A First Experience

Öberg

Martus

2019

Perit Dial Int

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Background Continuous flow peritoneal dialysis (CFPD) is performed using a continuous flux of dialysis fluid via double or dual-lumen PD catheters, allowing a higher dialysate flow rate (DFR) than conventional treatments. While small clinical studies have revealed greatly improved clearances using CFPD, the inability to predict ultrafiltration (UF) may confer a risk of potentially harmful overfill. Here we performed physiological studies of CFPD in silico using the extended 3-pore model. Method A 9-h CFPD session was simulated for: slow (dialysate to plasma creatinine [D/P crea] < 0.6), fast (D/P crea > 0.8) and average (0.6 < D/P crea < 0.8) transporters using 1.36%, 2.27%, or 3.86% glucose solutions. To avoid overfill, we applied a practical equation, based on the principle of mass-balance, to predict the UF rate during CFPD treatment. Results Increasing DFR > 100 mL/min evoked substantial increments in small- and middle-molecule clearances, being 2 - 5 times higher compared with a 4-h continuous ambulatory PD (CAPD) exchange, with improvements typically being smaller for average and slow transporters. Improved UF rates, exceeding 10 mL/min, were achieved for all transport types. The β2-microglobulin clearance was strongly dependent on the UF rate and increased between 60% and 130% as a function of DFR. Lastly, we tested novel intermittent-continuous regimes as an alternative strategy to prevent overfill, being effective for 1.36% and 2.27%, but not for 3.86% glucose. Conclusion While we find substantial increments in solute and water clearance with CFPD, previous studies have shown similar improvements using high-volume tidal automated PD (APD). Lastly, the current in silico results need confirmation by studies in vivo.

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confidence: 99%

Computer Simulations of Continuous Flow Peritoneal Dialysis Using the 3-Pore Model—A First Experience

Öberg

Martus

2019

Perit Dial Int

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“…In total, 21 records were included for review. 11,12,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37]…”

Section: Selectionmentioning

confidence: 99%

Evidence on continuous flow peritoneal dialysis: A review

Vries

Gelder

Cappelli

et al. 2022

Seminars in Dialysis

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Clinical application of continuous flow peritoneal dialysis (CFPD) has been explored since the 1960s, but despite anticipated clinical benefits, CFPD has failed to gain a foothold in clinical practice, among others due to the typical use of two catheters (or a dual‐lumen catheter) and large dialysate volumes required per treatment. Novel systems applying CFPD via the existing single‐lumen catheter using rapid dialysate cycling may solve one of these hurdles. Novel on‐demand peritoneal dialysate generation systems and sorbent‐based peritoneal dialysate regeneration systems may considerably reduce the storage space for peritoneal dialysate and/or the required dialysate volume. This review provides an overview of current evidence on CFPD in vivo. The available (pre)clinical evidence on CFPD is limited to case reports/series with inherently nonuniform study procedures, or studies with a small sample size, short follow‐up, and no hard endpoints. Small solute clearance appears to be higher in CFPD compared to conventional PD, in particular at dialysate flows ≥100 mL/min using two single‐lumen catheters or a double‐lumen catheter. Results of CFPD using rapid cycling via a single‐lumen catheter are too preliminary to draw any conclusions. Continuous addition of glucose to dialysate with CFPD appears to be effective in reducing the maximum intraperitoneal glucose concentration while increasing ultrafiltration efficiency (mL/g absorbed glucose). Patient tolerance may be an issue since abdominal discomfort and sterile peritonitis were reported with continuous circulation of the peritoneal dialysate. Thus, well‐designed clinical trials of longer duration and larger sample size, in particular applying CFPD via the existing catheter, are urgently required.

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“…Continuous flow PD (CFPD) using two PD catheters has been shown to significantly increase clearance and ultrafiltration during PD and research looking at gravity-assisted techniques show promise compared with attempting to do this with adapted automated machines ( 20 ).…”

Section: Acute Kidney Replacement Therapy—peritoneal Dialysismentioning

confidence: 99%

Perspectives: Neonatal acute kidney injury (AKI) in low and middle income countries (LMIC)

et al. 2022

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Neonatal AKI (NAKI) remains a challenge in low- and middle-income countries (LMICs). In this perspective, we address issues of diagnosis and risk factors particular to less well-resourced regions. The conservative management pre-kidney replacement therapy (pre-KRT) is prioritized and challenges of KRT are described with improvised dialysis techniques also included. Special emphasis is placed on ethical and palliation principles.

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Continuous flow peritoneal dialysis (CFPD) improves ultrafiltration in children with acute kidney injury on conventional PD using a 4.25 % dextrose solution

Abstract: Continuous flow peritoneal dialysis improves UF in fluid overloaded infants who are not achieving adequate UF on conventional PD.

Cited by 14 publications

References 11 publications

Computer Simulations of Continuous Flow Peritoneal Dialysis Using the 3-Pore Model—A First Experience

Computer Simulations of Continuous Flow Peritoneal Dialysis Using the 3-Pore Model—A First Experience

Evidence on continuous flow peritoneal dialysis: A review

Perspectives: Neonatal acute kidney injury (AKI) in low and middle income countries (LMIC)

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