Tidal peritoneal dialysis: preliminary experience.
OBJECTIVE
To determine the feasibility of home tidal peritoneal dialysis (TPD) and to assess whether eight hours of TPD can achieve uremia control and urea removal equal to that of continuous cycling peritoneal dialysis (CCPD).


METHODS
An open enrollment pilot study.


METHODS
The Home Dialysis Training Center of the University of Iowa Hospitals and Clinics, a tertiary care teaching hospital.


METHODS
Nine patients experienced with CCPD and living 80 km to 280 km from the dialysis center began TPD, because they wished to decrease their dialysis time.


METHODS
Following baseline measurements, each patient was taught to perform TPD. TPD consisted of an initial fill volume of 40 mL/kg, a residual volume approximately 20 mL/kg, and tidal exchanges of 10 to 20 mL/kg to achieve the desired hourly flow rate. Clinic assessments took place every four to six weeks, and prescriptions were subsequently altered to attain urea removal equal to that of CCPD.


METHODS
Patient interviews were used to determine TPD acceptance. Prior to each clinic visit, dialysate effluent volume and dialysis duration were recorded, and a sterile sample of the effluent was obtained for urea, creatinine, and total nitrogen measurement.


RESULTS
Urea and creatinine clearances increased with dialysate flow. Dialysate nonurea nitrogen was 3.0 +/- 0.2 mmol/kg/D and changed minimally with increasing dialysate volumes. Eight hours of TPD (initial fill: 40 mL/kg; residual volume: 20 mL/kg; tidal inflow: 20 mL/kg) with hourly tidal flow exceeding 40 mL/kg/hr and no daytime volume achieved urea removal equal to that of the patient's prior CCPD prescription.


CONCLUSIONS
TPD can provide dialysis equal to that of CCPD within a shorter amount of time (eight vs ten hours), but uses a greater volume of dialysate (16.0 L for TPD vs 9.5 L for CCPD).
Flanigan
M J
MJ
Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City 52240.
Doyle
C
C
Lim
V S
VS
Ullrich
G
G
D000293:Adolescent; D002648:Child; D015314:Dialysis Solutions; D005240:Feasibility Studies; D005260:Female; D006699:Home Care Services; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000295:instrumentation / Q000379:methods*; D013997:Time Factors
D015314:Dialysis Solutions