Mixed-mode therapy: kinetic analysis and acute clinical evaluation.
A mixed therapeutic modality was devised in which patients with chronic renal failure were treated with a combination of continuous ambulatory peritoneal dialysis (CAPD; two daily 4-hour exchanges per day; 16 h dry belly) and hemodialysis (1 session per week). Kinetic modeling analysis indicated that a time-averaged urea concentration equivalent to CAPD could be obtained with a Kt/V value of 1.2-1.6, depending on patient parameters, for the single-weekly hemodialysis. The therapy format was acutely evaluated in a 2-week clinical trial on 4 patients. Excursions in small-solute concentration were virtually equivalent to those predicted from theory. Adequate fluid removal was obtained in the 2 CAPD exchanges and blood pressure was well controlled. As a result of the success of the acute trials, and since this format may offer potential lifestyle advantages to patients who possess dual access, a chronic trial of mixed-mode therapy seems advised.
Lysaght
M J
MJ
Baxter Center for Medical Research, Sydney, Australia.
Moran
J E
JE
Schindhelm
K
K
Hayes
J M
JM
Farrell
P C
PC
D000368:Aged; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003198:Computer Simulation; D003404:Creatinine / Q000378:metabolism; D005260:Female; D006801:Humans; D007700:Kinetics; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D006435:Renal Dialysis / Q000379:methods*; D014508:Urea / Q000378:metabolism
D014508:Urea; D003404:Creatinine