NDLI: Intermittent peritoneal dialysis: urea kinetic modeling and implications of residual kidney function.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Guest, Steven Akonur, Alp Ghaffari, Arshia Sloand, James Leypoldt, John K.
Description	Country affiliation: United States Author Affiliation: Guest S ( Baxter Healthcare, Renal Division, McGaw Park, Illinois, USA. steven_guest@baxter.com)
Abstract	BACKGROUND: Intermittent peritoneal dialysis (IPD) is an old strategy that has generally been eclipsed, in the home setting, by daily peritoneal therapies. However, for a select group of patients with exhausted vascular access or inability to receive PD at home, in-center IPD may remain an option or may serve as an incremental strategy before initiation of full-dose PD. We investigated the residual kidney clearance requirements necessary to allow thrice-weekly IPD regimens to meet current adequacy targets. METHODS: The 3-pore model of peritoneal transport was used to examine 2 thrice-weekly IPD dialysis modalities: 5 - 6 dwells with 10 - 12 L total volume (low-dose IPD), and 50% tidal with 20 - 24 L total volume (high-dose IPD). We assumed an 8-hour dialysis duration and 1.5% dextrose solution, with a 2-L fill volume, except in tidal mode. The PD Adequest application (version 2.0: Baxter Healthcare Corporation, Deerfield, IL, USA) and typical patient kinetic parameters derived from a large dataset [data on file from Treatment Adequacy Review for Gaining Enhanced Therapy (Baxter Healthcare Corporation)] were used to model urea clearances. The minimum glomerular filtration rate (GFR) required to achieve a total weekly urea Kt/V of 1.7 was calculated. RESULTS: In the absence of any dialysis, the minimum residual GFR necessary to achieve a weekly urea Kt/V of 1.7 was 9.7 mL/min/1.73 m(2). Depending on membrane transport type, the low-dose IPD modality met urea clearance targets for patients with a GFR between 6.0 mL/min/1.73 m(2) and 7.6 mL/min/1.73 m(2). Similarly, the high-dose IPD modality met the urea clearance target for patients with a GFR between 4.7 mL/min/1.73 m(2) and 6.5 mL/min/1.73 m(2). CONCLUSIONS: In patients with residual GFR of at least 7.6 mL/min/1.73 m(2), thrice-weekly low-dose IPD (10 L) achieved a Kt/V urea of 1.7 across all transport types. Increasing the IPD volume resulted in a decreased residual GFR requirement of 4.7 mL/min/1.73 m(2) (24 L, 50% tidal). In patients with residual kidney function and dietary compliance, IPD may be a viable strategy in certain clinical situations.
File Format	HTM / HTML
ISSN	08968608
e-ISSN	17184304
DOI	10.3747/pdi.2011.00027
Journal	Peritoneal Dialysis International
Issue Number	2
Volume Number	32
Language	English
Publisher	Multimed
Publisher Date	2012-03-01
Publisher Place	Canada
Access Restriction	Open
Subject Keyword	Discipline Nephrology Kidney Failure, Chronic Physiopathology Therapy Kidney Peritoneal Dialysis Urea Pharmacokinetics Models, Biological Metabolism
Content Type	Text
Resource Type	Article
Subject	Nephrology

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